HLTEN504A - INCP

Stoma Care

Stoma– is a surgically created mouth-like opening produced by bringing an internal organ to the surface of the body, usually the abdominal wall.• Ileostomy – is the surgical

formation of an opening of the ileum onto the surface of the abdomen

• Colostomy – is the surgical formation of an opening of the colon onto the surface of the abdomen

Formation of ostomies

Loop colostomy is usually performed in a medial emergency when closure of the colostomy is anticipated. • They are often temporary. • A communicating wall remains between the proximal

and distal bowel. • The proximal end drains stool whereas the distal

portion drains mucus. • Within 7 to 10 days the supporting structure is

removed.

Formation of ostomies (cont)

Single-barrel (end) ostomy – when the proximal end of the bowel (colon or ileum) is brought to the surface of the abdomen and the distal portion of the GI tract is either removed or sewn closed

Formation of ostomies (cont)

Double-barrel colostomy is when the two ends of the bowel are brought to the surface and it is made of two distinct stomas.

The closer the stoma is to the proximal part of the bowel the more fluid the contents will be as it would be normally anyway. Sometimes the regularity of the movement can be achieved by administering routine enemas. A plug can sometimes be inserted for wear when the person doesn't want to wear a bag.Site of a stoma

– Depends on which part of the bowel is affected– Permanent or temporary– Site must be clear of natural skin creases, bony prominences,

old scars and the new abdominal wound– Consideration given to the person's physique, occupation etc– Stomal therapist nurses often perform siting for stomas in

consultation with the patient and surgeon in order to determine the most appropriate location

End colostomy

Loop colostomy

With bridge

Normal colour Abnormal colour

Irritated skin

Prolapsed

Retracted

Skin creases

Stenosis

Parastomal Hernia - Abnormal swelling around the stoma due to a weakness of the muscle wall.

Changing the appliance

Empty when pouch if one third full

Change bag if leakage

Use caulking agents, such as stomadhesive and a barrier wafer to secure pouch

Stoma bags usually come with one way charcoal activated filters (reduce gas build-up and odour from bag)

Nursing careIf client unable to attend to self-care of stoma appliance:– Collect equipment– Prepare area – privacy, air-freshener– Prepare client – shower, bedside?– Standard precautions apply– Remove old appliance and dispose of appropriately– Wash area carefully and dry– Check stoma and surrounding skin– Clip hair or shave if required (for adhesion of bag)– Check measuring guide and cut appliance (wafer) to fit (no

more than 0.5cm larger than stoma)– Don’t remove wafer if clip-on appliance – unless needed– Application of skin prep (helps adhesion)– Remove backing from pouch/ flange– Centre opening over stoma and press ensuring total seal– Complete procedure and adjust clothing– Document findings and report

Diet and stoma management

Low residue initially depending on site

Patients with ileostomy will need to remain on a low residue diet

If high residual must be chewed well

Avoid foods that cause excessive gas or odour

Foods that increase stool odour~ Asparagus, beans, cabbage, eggs, fish,

garlic, onions and some spicesFoods that increase gas

~ Beer, broccoli, Brussels sprouts, cabbage, carbonated drinks, cauliflower, corn, cucumbers, dairy products, onions, peas, radishes, spinach, spring beans

Foods that thicken stools~ Bananas, bread, cheese, yoghurt, pasta,

rice, tapioca, smooth peanut butterFoods that loosen stools

~ Chocolate, dried beans, fried foods, highly spiced foods, leafy green vegetables, raw fruits and juices, raw vegetables

Foods that may cause blockagePopcorn, corn, nuts, cucumber, celery, fresh tomatoes, strawberries, figsSigns and symptoms of blockage

» Abdominal cramping» Swollen stoma» Absence of output - longer than 4-6 hours if

ileostomyManagement

» Warm bath/ shower, knee chest position, drink warm fluids, massage peri-stomal area, change pouch to larger opening one,

» Report and refer if no resolution

Complications

Skin irritation, recurrent leaks around the pouch or skin barrier, excessive bleeding in, on, or around the stoma, blood in stool, a change in colour or consistency of stool, a bulge in the skin around the stoma, stoma appears to be getting longer.