2 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 abdomenColostomy – is the surgical formation of an opening of the colon onto the surface of the abdomen
4 Formation of ostomiesLoop 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.
7 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
8 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.
9 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 stomaDepends on which part of the bowel is affectedPermanent or temporarySite must be clear of natural skin creases, bony prominences, old scars and the new abdominal woundConsideration given to the person's physique, occupation etcStomal therapist nurses often perform siting for stomas in consultation with the patient and surgeon in order to determine the most appropriate location
13 Parastomal Hernia - Abnormal swelling around the stoma due to a weakness of the muscle wall.
14 Changing the appliance Empty when pouch if one third fullChange bag if leakageUse caulking agents, such as stomadhesive and a barrier wafer to secure pouchStoma bags usually come with one way charcoal activated filters (reduce gas build-up and odour from bag)
15 Nursing careIf client unable to attend to self-care of stoma appliance:Collect equipmentPrepare area – privacy, air-freshenerPrepare client – shower, bedside?Standard precautions applyRemove old appliance and dispose of appropriatelyWash area carefully and dryCheck stoma and surrounding skinClip 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 neededApplication of skin prep (helps adhesion)Remove backing from pouch/ flangeCentre opening over stoma and press ensuring total sealComplete procedure and adjust clothingDocument findings and report
16 Diet and stoma management Low residue initially depending on sitePatients with ileostomy will need to remain on a low residue dietIf high residual must be chewed wellAvoid foods that cause excessive gas or odour
17 Foods that increase stool odour Asparagus, beans, cabbage, eggs, fish, garlic, onions and some spicesFoods that increase gasBeer, broccoli, Brussels sprouts, cabbage, carbonated drinks, cauliflower, corn, cucumbers, dairy products, onions, peas, radishes, spinach, spring beansFoods that thicken stoolsBananas, bread, cheese, yoghurt, pasta, rice, tapioca, smooth peanut butterFoods that loosen stoolsChocolate, dried beans, fried foods, highly spiced foods, leafy green vegetables, raw fruits and juices, raw vegetables
18 Foods that may cause blockage Popcorn, corn, nuts, cucumber, celery, fresh tomatoes, strawberries, figsSigns and symptoms of blockageAbdominal crampingSwollen stomaAbsence of output - longer than 4-6 hours if ileostomyManagementWarm bath/ shower, knee chest position, drink warm fluids, massage peri-stomal area, change pouch to larger opening one,Report and refer if no resolution
19 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.