CNA Basic Nursing Skills 12 2 — Questions and Answers

Question 1: A patient with a colostomy tells the CNA the pouch is leaking. The CNA should FIRST:

Apply tape over the leak and continue other tasks
Report the leak to the charge nurse and assist with pouch change per care plan (Correct answer)
Remove the entire appliance immediately without notifying the nurse
Tell the patient the pouch will be changed at the next scheduled time

Correct answer: Report the leak to the charge nurse and assist with pouch change per care plan

A leaking colostomy pouch exposes skin to stool, causing chemical skin irritation. The nurse must be notified so a pouch change can be initiated per the individualized ostomy care plan.

Colostomy drainage is highly alkaline or contains digestive enzymes that quickly break down peristomal (skin around the stoma) tissue if allowed to contact it. A leaking pouch must be addressed promptly to prevent peristomal skin breakdown. The CNA notifies the nurse, gathers supplies, and assists with the pouch change according to the care plan. If the CNA is trained in ostomy care and the facility's policy permits, they may change the pouch. Taping a leaking pouch only delays proper cleaning and worsens skin damage.

Question 2: Normal-appearing colostomy stoma output should be:

Black and tarry with a strong metallic odor
Moist, pink-red in color, and may vary from liquid to formed depending on location (Correct answer)
Dry, pale, and white with no odor
Purple or blue-tinged with bright red streaks

Correct answer: Moist, pink-red in color, and may vary from liquid to formed depending on location

A healthy stoma is moist and pink-red (similar to mucous membranes); stool consistency depends on the type of colostomy — ascending/transverse produces more liquid stool while descending/sigmoid produces more formed stool.

Stoma assessment is an important observation duty for the CNA. Normal findings: pink to red color (indicating good blood flow), moist appearance, slight protrusion from abdominal wall, and no pain (stoma tissue has no nerve endings). Abnormal findings that must be reported: dark purple or black color (ischemia/necrosis), retraction into the abdomen, prolapse (extending out too far), unusual bleeding, severe swelling, or strong odors beyond normal stool smell. Stool consistency varies by colostomy type: right-sided (ascending) produces liquid output; left-sided (sigmoid/descending) produces more formed stool similar to normal defecation.

Question 3: When performing colostomy care, which action BEST protects the peristomal skin?

Applying talcum powder generously around the stoma
Using a skin barrier wafer cut to fit snugly within 1/8 inch of the stoma (Correct answer)
Stretching the skin opening as wide as possible for easy fitting
Applying thick petroleum jelly directly to the stoma

Correct answer: Using a skin barrier wafer cut to fit snugly within 1/8 inch of the stoma

A properly sized skin barrier wafer with a hole cut to leave only 1/8 inch clearance around the stoma protects the surrounding skin from contact with drainage.

The skin barrier (wafer) is the most critical element of peristomal skin protection. It must be: (1) cut to leave only 1/8 inch (3 mm) of exposed skin around the stoma, (2) smooth and wrinkle-free against the skin for a complete seal, and (3) changed every 3–5 days or sooner if leaking. Too large an opening exposes peristomal skin to drainage. Talcum powder can interfere with the adhesive seal. Petroleum jelly over the stoma coats the mucosa and prevents proper drainage collection. Touching or covering the stoma itself with the barrier wafer can cause pressure damage to the stoma tissue.

Question 4: A patient with a new colostomy appears embarrassed and refuses to look at the stoma. The CNA should:

Insist the patient participate in ostomy care immediately
Acknowledge the patient's feelings and provide care without judgment while encouraging gradual acceptance (Correct answer)
Perform care quickly without discussing it to avoid the topic
Tell the patient their reaction is normal but they must learn to care for it today

Correct answer: Acknowledge the patient's feelings and provide care without judgment while encouraging gradual acceptance

Body image adjustment after a new colostomy takes time; the CNA provides empathetic, non-judgmental care and encourages gradual patient involvement as the patient becomes ready.

Receiving a colostomy is a significant life change that affects body image, self-esteem, and quality of life. Many patients go through stages of grief similar to other major losses. The CNA plays a key role in normalizing the experience through consistent, matter-of-fact care delivery. Strategies include: acknowledging feelings ('I understand this is a big adjustment'), maintaining the patient's dignity during care, providing brief informational comments without overwhelming instruction, and not forcing participation until the patient signals readiness. Self-care education is an important goal but must be phased appropriately — the nurse and enterostomal therapy nurse coordinate the teaching plan.

Question 5: What does the term 'stoma' refer to in the context of ostomy care?

The surgical incision used to create the colostomy
The opening created surgically in the abdomen to divert intestinal contents to the body surface (Correct answer)
The specialized ostomy collection bag
The medication applied to prevent skin breakdown

Correct answer: The opening created surgically in the abdomen to divert intestinal contents to the body surface

A stoma is the surgically created opening in the abdominal wall through which bowel contents exit the body into a collection pouch.

A stoma (from the Greek for 'mouth' or 'opening') is the surgically created opening on the abdominal wall. In a colostomy, a portion of the colon is brought to the surface and sutured to the skin, creating the stoma. In an ileostomy, the ileum (small intestine) is used. In a urostomy, the ureters are redirected to a stoma for urine drainage. The stoma is typically 1–2 inches in diameter, protrudes slightly, and is bright pink/red in color. The pouch system (bag + skin barrier) is the collection device that attaches to the skin around the stoma.

Question 6: How often should an ostomy pouch typically be emptied to prevent leakage and odor?

Once every 24 hours, at bedtime
When it is one-third to one-half full (Correct answer)
Only when the patient requests it
Every 4 hours on a fixed schedule regardless of fill level

Correct answer: When it is one-third to one-half full

Emptying the pouch when it reaches one-third to one-half capacity prevents the weight of the contents from breaking the seal and causing a leak.

An overfilled ostomy pouch creates several problems: the weight increases the mechanical stress on the adhesive seal, raising leak risk; gas buildup can loosen the wafer; and a full pouch pressing against clothing is noticeable and uncomfortable for the patient. Standard practice is to empty the drainable pouch at the one-third to one-half full mark. When emptying, the CNA positions the patient in an appropriate location (usually the bathroom), opens the bottom closure, drains contents into the toilet, rinses the inside of the pouch with water, and reseals the closure. Gloves and hand hygiene are required throughout.

CNA Basic Nursing Skills 12 2

A patient with a colostomy tells the CNA the pouch is leaking.
The CNA should FIRST: