Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Sample Ostomy Teaching Record
Before Surgery: Teaching Completed Date & Initial
Date of surgery  
Type of surgery/ostomy  
Reason for surgery  
E.T. Nurse visit  
Stoma site selection and marking  
Stoma location and appearance  
Given teaching booklets about surgery  
Given samples of pouching system  
Purpose of pouch and skin barrier  
Knowledge of others with an ostomy  
Viewed ostomy video  

 

After Surgery: While in Hospital Teaching Completed Date & Initial Date & Initial
Stoma (size, swelling, shrinkage and appearance)  
Type of drainage while in hospital  
Observe/assist with pouch emptying  
Independent with pouch emptying  
Observe/assist with release of gas from pouch  
Independent with release of gas from pouch  
Observe/assist with pouch and skin barrier change  
Discuss odour control options  
Signs of pouch leakage (prevention and treatment)  
Viewed ostomy video and given teaching booklet (if not done pre-op)  
Who to call if problems occur after discharge from hospital  

 

After Surgery: Discharged Home Teaching Completed Date & Initial Date & Initial
Type of drainage at home  
Stoma (size, swelling, shrinkage and appearance)  
Independent with pouch emptying  
Observe/assist with pouch and skin barrier change  
Independent with pouch and skin barrier change  
Signs of pouch leakage (prevention and treatment)  
Skin breakdown (prevention and treatment)  
Application instructions  
Supply list/where to buy  
Care of supplies/emergency kit  
Discuss odour control options  
Nutrition/dietary instructions  
Bathing  
Activity/travel  
Clothing modifications  
Sexual function concerns  
Financial Assistance (A.D.P., DVA, Private Insurance, Social Assistance, Disability)  
United Ostomy Association of Canada Support Group  
Ostomy visitor  
Discharge instructions  

 

Colostomy: Teaching Completed Date & Initial Date & Initial
Care of perineal wound (if present)  
Mucous drainage per rectum (if rectum left in place)  
Care of a mucous fistula (if present)  
Colostomy irrigation information  
Trial of a colostomy irrigation (optional)  
Constipation/diarrhea/gas  

 

Ileostomy: Teaching Completed Date & Initial Date & Initial
Care of perineal wound (if present)  
Mucous drainage per rectum (if rectum left in place)  
Sodium loss and replacement  
Potassium loss and replacement  
Obstruction and management  
Fluid imbalance and treatment  
Medication  

 

Urostomy: Teaching Completed Date & Initial Date & Initial
Connecting pouch to additional leg bag (optional)  
Connecting pouch to bedside drainage (optional)  
Care of bedside drainage container and/or leg bag  
Mucous in urine  
Fluid intake/cranberry juice  
Urinary tract infection  
Urine sample from stoma  

Nurse’s Signature:                           Initials              Nurse’s Signature:                           Initials
__________________________  ___________    __________________________  ___________  
__________________________  ___________    __________________________  ___________  

Reproduced with permission from ET NOW, CarePartners, Waterloo, Ontario.