Appendix G: Sample Assessment Form - All Available Guidelines ... - pda rnao 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the CORE INFORMATION section. Enter the surgery date, type of ostomy, and whether it is permanent or temporary. Make sure to specify the approximate closure date if applicable.
3. Proceed to the ASSESSMENT section. For each appliance change within the first six weeks, initial the appropriate assessment fields. Measure stoma size using a measuring guide and note its color and appearance.
4. In the MUCOCUTANEOUS JUNCTION section, indicate whether it is intact or separated. Then, assess peristomal skin color and integrity, noting any issues such as maceration or rash.
5. Document effluent characteristics for both stool and urine, including texture, color, clarity, and output levels.
6. Finally, record patient perception and details about the ostomy appliance used. Ensure all signatures are completed where required.

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