Definition of Stoma. Stoma (Greek word) meaning mouth or opening. The surgery to create the new opening in the abdomen is called ostomy
12/01/2016
Tips and Tricks For Effective Care Of A Patient With A Stoma NC Phyllis Tan Dip. in Nursing, Adv. Dip in Nursing (Medical-Surgical). Bsc i...
Tips and Tricks For Effective Care Of A Patient With A Stoma NC Phyllis Tan Dip. in Nursing, Adv. Dip in Nursing (Medical-Surgical). Bsc in Health Science (Nursing) Nurse Clinician Nursing Adminstration
9 January 2016
Definition of Stoma Stoma (Greek word) meaning mouth or opening. The surgery to create the new opening in the abdomen is called ostomy. A stoma can be a permanent or temporary.
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3 basic types of eliminating stoma: 1.
COLOSTOMY - An opening into the colon
2.
ILEOSTOMY - An opening into the ileum
3.
UROSTOMY - An opening into the urinary tract
Permanent Stoma Constructed when the colon/ rectum is removed.
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Temporary Stoma • Reversed between 6 weeks - 6 months • Purpose to divert fecal stream away from: – Obstruction – Infection – New anastomosis
Alterations of colon content consistency mushy Semi-solid Semi-liquid Solid
Fluid Firm Solid Left side: Faecal matter more solid as water reabsorbed Right side: Increased liquid effluent Transverse colon: Consistency of effluent depends on specific location
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End Stoma
The end of the bowel is everted at the skin surface as a bud.
Loop Stoma • Anterior wall of the bowel is transected longitudinally or transversely.
• Consists of: – Distal (non-functioning) also known as mucous fistula – Proximal (functioning)
• Often created in transverse colon or ileum as temporary stoma.
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Loop Stoma
Stoma rod
Stoma Assessment
• Characteristics • Peristomal skin condition • Integrity of stoma appliance • Nature of stoma output
Complications- Prolapse Management : Hypertonic packing if unable to reduce or if stoma is edematous.
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Complications- Peristomal Dehiscence Management: Prevention of fecal contamination. • Flush area of dehiscence using syringe and water. • Dry with gauze. • Pack with wound products such as kaltostat or aquacel (available at pharmacy) to level of abdominal wall.
Area of dehiscence
Excoriation Wound product
Stomahesive paste
• Cover packed site with stomahesive paste. • Apply stoma appliance over. Stomahesive powder Stomahesive paste
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Complications- Skin Excoriation
On admission
Day 1 after treatment
Day 3 after treatment
Leakage
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Wound in close proximity
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Selection of stoma care appliance • Type of stoma • Nature of effluent
• Frequency of change • Body structure • Psychosocial factor Carer vs self care Financial
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Principles of Pouching The skin must be protected from • Effluent • Mechanical trauma • Product related irritation The stoma must be protected from trauma
How to apply stoma appliance?
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Steps to Application of Stoma Appliance
• Thorough skin cleansing with tap water.
• No need for sterile solution.
Tracing of stoma size on transparent sheet.
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Transcribe drawing on transparent sheet to back of stoma appliance. Cut stoma appliance according to transcribed drawing.
• Remove white paper on back of stoma appliance. • Paste adhesive side to body.
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Key points to remember Approximately 2mm of the skin should clear between the skin barrier or pouch. Stomal mucosa starts to lose surgical edema around 2nd or 3rd week post surgery and continues to shrink up to 6 months. Maximum shrinkage takes place around the 6th week.
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Stoma Care •
Appearance of healthy stoma: – Red and moist – Opening in the centre – Functioning – observe output
•
Medical advice should be seeked if output is more than 1litre. – Hydration is important to compensate for fluid loss.
Stoma Care • When changing the appliance: – Gently remove the appliance – Cleanse the surrounding skin with water and soft material (i.e, cotton balls). – Inspect your stoma and surrounding skin on a regular basis. Contact your principle nurse for advice on any abnormalities. – Avoid use of cream/ lotions on skin around the stoma as these will interfere with adherence – Appliance changes should be planned, regular basis, rather than emergency responses to leakage.
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Lifestyle Modification • Dietary guideline – No single diet for everyone. Try small amount of new food one at a time, assess for tolerance and learn which food to eat or avoid. – Prevent obstruction: • Take plenty of fluids (also to prevent dehydration) • Chew on food thoroughly to facilitate digestion • Consume food that are low in fiber
Lifestyle Modification • Dietary guideline - stoma – Avoid food that is likely to cause gas or odour
– Gas: often due to swallowed air. Eat slowly, in a relaxed setting to prevent swallowing of air. – Prevent dehydration by drinking 8 to 12 glasses of water per day if not contraindicated.
Alcohol Raw fruits Grape and apple juices Green beans prunes / prune juice Spicy poor fried foods High-sugar foods Spinach coffee
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Lifestyle Modification • Bathing – Bathe/shower with the entire appliance on, or off on days due for change. – Water or soap will not damage your stoma; just rinse the soap off thoroughly. – Do not let water fall directly on your stoma – Hot/warm tubs allowed but long soaks in it may lessen the normal wear time of the appliance and may need more frequent change
Lifestyle Modification • You can resume activities like before. – Always carry extra set of appliances when going out.
• Exercise – Can continue exercise and be active in sports as before – The ostomy does not in itself prevent you from exercises but depends on whether you feel fit
• Clothing – likely not be obvious under your clothing.
