Presentation on theme: "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."— Presentation transcript:
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 colourAbnormal 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 care If 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 spices Foods 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 butter Foods that loosen stools ~Chocolate, dried beans, fried foods, highly spiced foods, leafy green vegetables, raw fruits and juices, raw vegetables
Foods that may cause blockage Popcorn, corn, nuts, cucumber, celery, fresh tomatoes, strawberries, figs Signs and symptoms of blockage »Abdominal cramping »Swollen stoma »Absence of output - longer than 4-6 hours if ileostomy Management »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.