Caring for a Patient with a Stoma 1

stoma

end of the ureter/small/large intestine that can be seen protruding through abdominal wall

ostomy

surgically created opening in the body for the discharge of body waste

describe a stoma

in tact blood supply

no nerve supply

red/pink colour

can be temp or permanent

name some conditions which predispose to stoma formation

IBD

carcinoma

familial adenoma polyposis

diverticulitis

trauma

incontinence

ulcerative colitis

inflammation of mucosa of colon

ulcerative colitis symptoms

bloody diarrhoea, urgency, mucus

anorexia

anaemia

abdominal discomfort

anal soreness and pain

fever

when is ostomy required in ulcerative colitis

medical treatment not adequate

risk of perforations or perforation has occured

risk of cancer

poor health

what does the ostomy procedure entail in ulcerative colitis

removal of full colon

sometimes rectum is left + ileum connected to it

crohns disease

inflammation and ulcerartion

can occur anywhere in GIT

Crohns symtoms

rectal bleeding

colicky pain after meals

chronic episodic diarrhoea

weight loss and anaemia

oral manifestation

crohns ostomy treatment

affected part is removed

bowel ends rejoined and protected by temporary ileostomy or colonostomy

risk of recurrence

familial polyposis coli

inherited condition

polyps form on large bowel - risk of malignancy

familial polyposis coli treatment

colon + rectum are removed

ileorectal anastomosis in some cases

ilerotectal anastomosis

ileum connected to rectum

diverticular disease

caused by lack of fibre in diet - high pressure in bowel

faeces become trapped in diverticula -> inflammation, pain and bleeding

diverticulitis symptoms

acute abdominal pain

fever

constipation or frequent defecation

abdominal mass

carcinoma - colorectal

cancer

insidious and symptoms are late

colorectal carcinoma symptoms

change in bowel habit

rectal bleeding

colorectal carcinoma treatment

surgery

chemo

biological therapy

radiotherapy

diseases predisposing to urostomy formation

spinal cord

malfunction

diabetic neuropathy

cancer

congenital defects

what is a temporary ostomy procedure

possibility of being reversed with another operation

minimum 6 weeks

what is a permanent ileostomy procedure

will not be reversed

can be due to not having enough bowel to create healthy pathway

3 most common ostomy procedures

colostomy

ileostomy

urostomy

colostomy

surgical opening of the large bowel

output = semisolid/ solid

odour can be an issue

stoma usually flush, skin may protrude

temporary loop colostomy

usually LHS

can be RHS above umbilicus

one stoma with two holes

can be reversed easily

terminal colostomy

usually on LHS

one stoma on abdomen wall

sometimes will have second stoma called mucous fistula

more complex reversing

ileostomy

opening from small intestine/ ileum

output = liquid/ semisolid containing digestive enzyme which can irritate the skin

protrudes 2-3cm

temporary loop ileostomy

usually RHS below umbilicus

first choice for temporary stoma

allows resting of whole colon

advantages of loop ileostomy over loop colostomy

less bulky

possible to site well to allow good management

effluent is more predicatble

terminal ileostomy

entire colon needs to be removed

ileum then brought out through a 2cm incision in rectum to a length of 6/7cm

sutured to abdominal wall - prevents from retracting

then turned inside out

urostomy

ileal conduit = most common

10-20cm isolated ileum with blood supply

ureters mobilised and attached into isolated ileum

other end used to form stoma

pre op patient prep

- 3 steps

early referral to stoma nurse

psychological prep

physical prep

psychological prep

improves recovery rate

prepare post op plan

counselling

physical prep

bowel evacuation

stoma siting

name some stoma sites to avoid

old scars, skin disorders

belly button

groin/ pubic areas

waistline

site which cannot be seen by patient

post op care

careful observation of stoma

monitor - size, swelling, temp, colour, quantity + consistency of material

pain

electrolyte balance

management

perianal wound care

3 types of bags

closed/ non drainable

drainable

urostomy

closed

no opening

used when faeces are well formed - colostomy

discard after use - 1/2x a day

fitted with integral flatus filter

drainable

open end

ileostomy pts always

colostomy - watery faeces

changed every 2-4 days

seal = clip or roll and click

urostomy bag

fitted with drainage table and anti reflux valve

change every 2-3 days

overnight drainage bags available

name some appliances

one piece

two piece - flange and bag

need to make sure appliances fit well to avoid complications