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Clinical Confidence • Student Nurse Guide

Understanding Stoma Assessment for Student Nurses

Learn what to observe when caring for a patient with a stoma, how to recognise changes in appearance, output and surrounding skin, and when findings should be communicated or escalated.

Clinical confidence principle: assess the stoma, the output and the patient. A change in one should always be interpreted alongside the others and compared with the patient's expected or usual pattern.
Foundation

What is a stoma?

A stoma is a surgically created opening that brings part of the bowel to the surface of the abdomen. Different types of stoma have different expected patterns of output, so assessment should always take account of the patient's individual situation and care plan.

Colostomy

Large bowel

A colostomy is formed from the colon. Output characteristics can vary depending on the site of the stoma and the individual patient.

Ileostomy

Small bowel

An ileostomy is formed from the ileum and its output is generally more liquid than output from many colostomies.

Individual care

Know the patient's baseline

The expected appearance and output should be understood in the context of the patient's surgery, recovery and established pattern.

Look systematically

Four areas to consider during stoma assessment

1

Stoma appearance

Observe colour, moisture, swelling and any significant change from the patient's expected appearance.

2

Stoma output

Consider the amount, consistency, colour and any significant change in output according to the type of stoma.

3

Peristomal skin

Observe the surrounding skin for soreness, irritation, breakdown, leakage or other changes.

4

The patient

Assess abdominal symptoms, hydration, oral intake, urine output, observations and overall clinical condition.

Appearance

What should you notice about the stoma itself?

Student nurses should become familiar with observing a stoma while recognising that interpretation depends on the patient's clinical circumstances and stage of recovery.

Colour

Observe tissue colour

Notice whether the stoma's colour appears consistent with its expected appearance or has changed significantly.

Moisture

Look at the surface

The bowel tissue forming the stoma normally has a moist appearance. Unexpected changes should be reported.

Shape

Notice structural change

Significant changes in size, protrusion, position or surrounding swelling should be communicated for further assessment.

Important: a stoma that becomes unusually dark, dusky, pale or otherwise significantly different from its expected appearance requires prompt assessment by an appropriately qualified clinician.
Output

Assess more than whether the bag contains stool

Feature What to assess Why it matters
Amount Has output increased, decreased or stopped compared with the expected pattern? A significant change may require further assessment.
Consistency Is the output liquid, loose, formed or different from usual? Consistency varies by stoma type, but a new change may be clinically relevant.
Colour Has the appearance of the output changed significantly? Unexpected changes should be considered alongside diet, medicines and the patient's condition.
Blood Is there unexpected or significant blood in the output? Bleeding should be assessed in context and communicated appropriately.
Trend How does current output compare with earlier observations? Changes over time are often more useful than a single isolated observation.
Fluid balance

High or changing output can affect the whole patient

Significant gastrointestinal fluid losses can contribute to dehydration and electrolyte disturbance. This makes fluid balance particularly important when stoma output becomes substantially greater than the patient's expected pattern.

Output

Track gastrointestinal losses

Measure and document output when this is required by the patient's care plan or local practice.

Intake

Consider replacement

Look at whether the patient is able to maintain adequate oral intake alongside ongoing losses.

Urine

Watch urine output

Reduced urine output alongside substantial gastrointestinal loss may add to concern about hydration and perfusion.

Connect the trend: increasing stoma losses + poor oral intake + falling urine output + changing physiological observations is more concerning than any single finding considered alone.
Skin assessment

Look after the skin around the stoma

The peristomal skin is exposed to potential irritation from moisture, leakage and appliances. Changes should be identified early and managed according to the patient's care plan and specialist advice.

Integrity

Check the skin

Look for redness, soreness, excoriation, broken skin or other changes.

Leakage

Check appliance fit

Repeated leakage can damage surrounding skin and may indicate that the appliance or care approach requires review.

Support

Know when to ask for help

Seek support from the registered nurse or specialist stoma team when significant skin problems or appliance difficulties occur.

Patient-centred care

A stoma assessment is also a conversation

Patients often develop considerable expertise in managing their own stoma. Their knowledge of what is normal for them can provide valuable information when something changes.

  • Ask what the patient's usual stoma output is like.
  • Ask whether they have noticed a change in appearance or function.
  • Ask about leakage, discomfort or problems with the appliance.
  • Respect privacy and dignity during stoma care.
  • Encourage appropriate independence rather than automatically taking over care.
  • Recognise anxiety or concerns about body image and adjustment.
Red flags

Changes that should increase concern

  • A significant unexpected change in stoma colour or appearance.
  • New or worsening abdominal pain or distension.
  • Persistent vomiting alongside a change in stoma function.
  • A substantial unexpected reduction or cessation of output with concerning symptoms.
  • Markedly increased output accompanied by signs of fluid loss.
  • Reduced urine output, poor intake or worsening hydration.
  • Unexpected significant bleeding.
  • Worsening physiological observations or general clinical condition.
Do not diagnose the cause from the stoma alone. Assess the patient systematically and escalate significant changes according to local procedures.
Clinical scenario

The output has changed

Example

A patient with an established ileostomy tells you that the output has become much more watery and frequent than usual.

During your assessment you learn that they have been drinking poorly. Their urine output has also fallen compared with earlier in the day.

Rather than concentrating only on the stoma bag, you recognise the pattern: increased gastrointestinal losses + reduced intake + reduced urine output.

You assess the patient's wider clinical condition and communicate the change promptly to the registered nurse.

Communication

Describe what has changed

Example escalation

“I'm concerned about Ms Patel. Her ileostomy output has become much more watery and frequent compared with her normal pattern. She has had poor oral intake today and her urine output has reduced.”

This communicates the stoma finding and explains why the wider pattern requires assessment.

Common mistakes

Errors to avoid

  • Looking at the appliance without assessing the patient.
  • Assuming all stomas should produce the same type of output.
  • Ignoring a significant change from the patient's normal pattern.
  • Failing to connect high output with fluid balance and urine output.
  • Ignoring the condition of the surrounding skin.
  • Overlooking the patient's own knowledge of their stoma.
  • Attempting specialist stoma management beyond your competence.
Clinical Confidence Routine

Stoma → output → skin → patient

Stoma Observe appearance and significant change.
Output Assess amount, consistency and trend.
Skin Check surrounding skin and appliance problems.
Patient Connect findings with symptoms, hydration and deterioration.
Educational resource: this NurseNet guide supports student learning and does not replace individual clinical assessment, specialist stoma advice, local policies, NEWS2, ABCDE, clinical supervision or professional judgement.
Continue Clinical Confidence

Assess the stoma and the whole patient

Confidence develops when you move beyond simply observing the appliance and connect stoma appearance and output with skin integrity, fluid balance, abdominal symptoms and the patient's wider clinical condition.

Explore Clinical Confidence →