stoma

Introduction to Stomal Therapy Nursing

Speaker Information

  • Helene Purdy, a Stomal Therapy Nurse, semi-retired, currently working with the Queensland Stoma Association.

  • Experience: Worked for many years in the private healthcare system as a thermal therapy nurse.

Role of a Stomal Therapy Nurse

Definition: A Stomal Therapy Nurse is a specialized registered nurse who has completed a postgraduate certificate in stoma care, which typically takes about eighteen months to accomplish.

Primary Responsibilities:

  • Counseling and Education: Provide education and counseling for patients pre-operatively regarding stoma care.

  • Stoma Site Selection: Assess and cite the stoma location pre-surgery. It is essential to choose a site without a belt line, pant line, or creases, to facilitate easier management for the client post-surgery.

  • Assessment: Evaluate the stoma and address any concerns raised by nursing staff.

  • Patient and Family Education: Teach clients and their families how to independently care for their stomas post-discharge.

  • Ostomy Supplies Assessment: Assess patients for suitable appliances before discharge from the hospital and provide ongoing guidance regarding living with a stoma.

  • Emergency Support: Maintain an emergency line to assist clients experiencing issues with their stomas.

  • Affiliation with Ostomy Associations: Help connect clients to ostomy associations, noting that there are six such associations in Queensland with the Queensland Stoma Association located at Chermside being the largest.

Understanding Ostomies

Definition: An ostomy is a surgically created opening (fistula) that diverts bodily waste from the intestines or urinary system.

Types of Ostomies:

  1. Colostomy: An opening into the colon.

  2. Ileostomy: An opening into the ileum (small intestine).

  3. Urostomy: An opening into the urinary tract.

Characteristics of a Stoma:

  • Appearance: Often described metaphorically as resembling a cherry, although it may not appear so.

  • Pain Perception: The stoma does not have nerve endings, thus can be touched without causing pain.

  • Showering Guidelines: Clients are encouraged to shower without their appliances and are reminded that slight bleeding when cleaned is normal due to high vascularity.

Stoma Types and Formation

Types of Stromas:

  1. Permanent: Creates a single opening for ongoing waste management.

  2. Temporary: Particularly a loop stoma, which can exist for a duration (often around three months) post-surgery until further treatments or assessments are completed.

Colostomy Formation:

  • Bowel is brought out and sutured to the abdomen.

  • The distal end (non-functioning) and proximal end (functioning) are established, with management of functionality being crucial.

Ileostomy Formation:

  • Segment of the ileum is brought out similarly to a colostomy.

  • May also include post-operative rod placements that are removed after stabilization.

Double Barrel Stoma:

  • Often seen in children.

  • Two ends of the bowel are brought through a single abdominal wall opening, making appliance selection more challenging due to space limitations.

  • Can also involve a mucous fistula (non-functioning discharge of mucus from the distal intestine).

Fistula Management:

  • Often associated with lower sigmoid colon cancers and surgical interventions to create an ostomy.

  • Closing methods can involve physically removing the fistula after successful treatment.

Colostomy Details

  • Constructed from any part of the colon: ascending, transverse, or descending.

  • Typically performed due to conditions like cancer or diverticular disease.

  • Post-operative diet: No food restrictions, encouraging normal dietary intake.

Ileostomy Details

  • Most common in patients suffering from ulcerative colitis, Crohn's disease, or cancer.

  • Output is usually fluid to semi-formed stools, with significant output of digestive enzymes responsible for skin irritation, necessitating dietary considerations, particularly regarding fiber intake to prevent blockages.

  • Normal output: 500-800 mL/day, requiring hydration of over two liters for fluid balance and prevention of dehydration.

Urostomy Details

  • Created from a segment of the intestine (typically terminal ileum) after bladder removal, primarily due to cancer.

  • Stents may be placed post-surgery to identify ureter positions, with eventual removal per usual protocol.

  • Urinary output considerations and dietary management strategies are necessary to prevent complications such as infections.

Appliance Types and Management

Types of Appliances:

  1. Closed Pouch: Non-drainable, often used for colostomies, requiring removal with each bowel movement.

  2. Drainable Pouch: Single or two-piece options used primarily in ileostomy cases to facilitate easier maintenance and hygiene.

Selection Considerations:

  • Client skin integrity, stoma site conditions, and individual preferences largely dictate the type and style of appliances utilized.

  • Managed through assessing the client's needs for effective and comfortable fitting.

Stomal Care and Hygiene

Cleaning

  • Use of moist wipes which could harm skin avoided, preference for soft cloths (like Chucks) recommended.

  • Adhesive removers and protective sprays discussed for skin protection and comfort during appliance change.

Practitioner-Client Interaction:

  • Nurses encouraged to communicate comfort levels and provide patient-centric care.

  • Sensitivity to clients' familiarity with their stomas emphasized for effective collaboration.

General Care Tips:

  • Appliance change frequency varies by type; closed pouches may require changes every 1-2 days while two-piece systems can last up to a week unless leaks occur.

  • Proper body mechanics while handling stomas, ensuring equipment availability to avoid unnecessary complications from appliance leaks.

Additional Tools and Strategies

  • Use of barrier wipes, powders, and protective seals to prevent leakage and maintain skin health.

  • Consideration of client emotional and psychological aspects to aid comfort and compliance with care regimes.

Conclusion

Key Takeaway: Mastery of stoma management includes education about types of stomas, their care, and sensitivity to the psychological aspects of living with such conditions while maintaining continuous communication with clients about their needs and experiences.

  • Helene ends the session with a note of encouragement for proper education and management of stomas, expressing gratitude for the opportunity to share her knowledge.