The patient with an ostomy needs physical and psychological support both preoperatively and postoperatively (Wasserman & McGee, 2017). Support can come from the patient's family/caregivers, significant others, members of the health care team, and people who have had similar experiences. Patients who receive consultation preoperatively and care postoperatively from an enterostomal therapy nurse or a wound ostomy continence nurse (WOCN) experience better long-term outcomes (Schreiber, 2016). Use the following guidelines to help promote the physical and psychological comfort of the patient with an ostomy:

• Keep the patient as free of odors as possible. Empty an ostomy appliance before it is half-full to reduce the risk of separation from the skin and leakage (Blevins, 2019; WOCN, 2018).
• Inspect the patient's stoma regularly. Note the size of the stoma, which usually stabilizes within 6 to 8 weeks (Stelton, 2019). It should ideally protrude about 1 to 3 cm above skin level and be dark pink to red in color and moist (Stelton, 2019). A pale stoma may indicate anemia and a dark or purple-blue stoma may reflect compromised circulation or ischemia and may initially appear swollen and edematous. After 6 weeks, the edema has usually subsided. Bleeding around the stoma and its stem should be minimal. The edges of the stoma should appear secure to the surrounding skin (Stelton, 2019). The pulling away of the stoma from the peristomal skin is called mucocutaneous separation or stoma dehiscence (Stelton, 2019) and occurs more often in patients who are at risk for impaired healing, including patients with diabetes, poor nutritional status or who received high-dose steroid therapy or chemotherapy before surgery (Butler, 2009). Notify the health care team promptly if bleeding persists or is excessive, or if color changes occur in the stoma or if it appears the stoma is separating from the peristomal skin (Stelton, 2019).
• Depending on the surgical technique, the final stoma may be flush with the skin. Erosion of skin around the stoma area can also lead to a flush stoma. If an abdominal dressing is in place at the surgical incision, check it frequently for drainage and bleeding. The dressing is usually removed after 24 hours.
• Keep the skin around the stoma site (peristomal area) clean and dry. Assess the peristomal (around the stoma) skin; peristomal skin should be intact and appear consistent with that of the rest of the abdomen, without pain or discomfort (Burch, 2018). In patients with light skin tones, the peristomal skin should not be reddened; in patients with darker skin tones, the skin should not have darker discolorations (Stelton, 2019). A leaking or ill-fitted stoma appliance will cause moisture-associated skin damage (Berti-Hearn & Elliott, 2019) (refer to the discussion earlier in the chapter). Candida or yeast infections can also occur around the stoma if the area is not kept dry.
• Measure the patient's fluid intake and output. Check the ostomy appliance for the quality and quantity of discharge. Initially after surgery, peristalsis may be inhibited. As peristalsis returns, stool will be eliminated from the stoma. Record intake and output every 4 hours for the first 3 days after surgery. If the patient's output decreases while intake remains stable, report the condition promptly.
• Explain each aspect of care to the patient and explain what their role will be when beginning self-care. Patient teaching is one of the most important aspects of ostomy care and should include family members, caregivers, and/or people identified by the patient to include in care, when appropriate. Teaching can begin before surgery, if possible, so that the patient has adequate time to absorb the information.
• Encourage the patient to participate in care and to look at the ostomy. Patients normally experience emotional depression during the early postoperative period. Help the patient cope by listening, explaining, and being available and supportive. A visit from a representative of the local ostomy support group may be helpful. Patients usually begin to accept their altered body image when they are willing to look at the stoma, make neutral or positive statements concerning the ostomy, and express interest in learning self-care.
• Provide support for the patient's physical, psychological, and social activities. Coping strategies need to address body image concerns, permanent body changes, and underlying health issue(s) that resulted in the surgery (Berti-Hearn & Elliott, 2019; Díaz et al., 2018). Encourage patients and their partner/family/caregiver to discuss concerns and to seek help and support (Berti-Hearn & Elliott, 2019; Chandler, 2020; Hill, 2020).