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Tips and Tricks For Effective Care Of A Patient With A Stoma

9 January 2016

NC Phyllis Tan Dip. in Nursing, Adv. Dip in Nursing (Medical-Surgical). Bsc in Health Science (Nursing) Nurse Clinician Nursing Adminstration

Definition of Stoma Stoma (Greek word) meaning mouth or opening.

The surgery to create the new opening in the abdomen is called ostomy.

A stoma can be a permanent or temporary.

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3 basic types of eliminating stoma:

1. COLOSTOMY - An opening into the colon

2. ILEOSTOMY - An opening into the ileum

3. UROSTOMY - An opening into the urinary tract

Permanent Stoma

Constructed when the colon/ rectum is removed.

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Temporary Stoma

• Reversed between 6 weeks - 6 months

• Purpose to divert fecal stream away from:

– Obstruction

– Infection

– New anastomosis

Alterations of colon content consistency

mushy

Semi-solid

Solid

Firm Solid Fluid

Semi-liquid

Left side: Faecal matter more solid as water reabsorbed

Right side: Increased liquid effluent

Transverse colon: Consistency of effluent depends on specific location

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End Stoma The end of the bowel is everted at the skin surface as a bud.

Loop Stoma • Anterior wall of the bowel is

transected longitudinally or transversely.

• Consists of: – Distal (non-functioning) also known as

mucous fistula

– Proximal (functioning)

• Often created in transverse colon or ileum as temporary stoma.

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Loop Stoma

Stoma rod

Stoma Assessment

• Characteristics

• Peristomal skin condition

• Integrity of stoma appliance

• Nature of stoma output

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Managing Stoma & Skin Problems

Complications

Prolapse Peristomal Dehiscence Muco-cutaneous separation +/- retraction

Hernia Necrosis Stricture

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Complications- Prolapse

Management: Manual reduction

Complications- Prolapse

Management : Hypertonic packing if unable to reduce or if stoma is edematous.

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Complications- Peristomal Dehiscence

Management: Prevention of fecal contamination.

• Flush area of dehiscence using syringe and water.

• Dry with gauze. • Pack with wound products such as

kaltostat or aquacel (available at pharmacy) to level of abdominal wall.

Wound product

Stomahesive paste

Stomahesive powder

Stomahesive paste

Area of dehiscence

Excoriation

• Cover packed site with stomahesive paste.

• Apply stoma appliance over.

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On admission Day 1 after treatment Day 3 after treatment

Complications- Skin Excoriation

Leakage

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Wound in close proximity

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Selection of stoma care appliance

• Type of stoma

• Nature of effluent

• Frequency of change

• Body structure

• Psychosocial factor

Carer vs self care

Financial

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Principles of Pouching

The skin must be protected from

• Effluent

• Mechanical trauma

• Product related irritation

The stoma must be protected from trauma

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How to apply stoma appliance?

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Steps to Application of Stoma Appliance

• Thorough skin cleansing with tap water.

• No need for sterile solution.

Tracing of stoma size on transparent sheet.

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Transcribe drawing on transparent sheet to back of

stoma appliance.

Cut stoma appliance according to transcribed drawing.

• Remove white paper on back of stoma appliance.

• Paste adhesive side to body.

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Key points to remember

Approximately 2mm of the skin should clear between the skin barrier or pouch.

Stomal mucosa starts to lose surgical edema

around 2nd or 3rd week post surgery and continues

to shrink up to 6 months.

Maximum shrinkage takes place around the 6th

week.

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Stoma Care

• Appearance of healthy stoma:

– Red and moist – Opening in the centre – Functioning – observe output

• Medical advice should be seeked if output

is more than 1litre. – Hydration is important to compensate for

fluid loss.

Stoma Care • When changing the appliance:

– Gently remove the appliance

– Cleanse the surrounding skin with water and soft material (i.e, cotton balls).

– Inspect your stoma and surrounding skin on a regular basis. Contact your principle nurse for advice on any abnormalities.

– Avoid use of cream/ lotions on skin around the stoma as these will interfere with adherence

– Appliance changes should be planned, regular basis, rather than emergency responses to leakage.

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Lifestyle Modification

• Dietary guideline

– No single diet for everyone. Try small

amount of new food one at a time, assess for tolerance and learn which food to eat or avoid.

– Prevent obstruction: • Take plenty of fluids (also to prevent

dehydration)

• Chew on food thoroughly to facilitate digestion

• Consume food that are low in fiber

Lifestyle Modification

• Dietary guideline - stoma

– Avoid food that is likely to cause gas or odour

– Gas: often due to swallowed air. Eat slowly, in a relaxed setting to prevent swallowing of air.

– Prevent dehydration by drinking 8 to 12 glasses of water per day if not contraindicated.

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Food that produces flatus/gas

• Carbonated beverages

• Beer

• Cucumbers

• Dried beans / peas / legumes

• Broccoli and cauliflower

• Cabbages / sauerkraut

• Brussel sprouts

• Onions

• Sweet potatoes

• Turkey

• Melons

Food that may cause odour • Fish

• Eggs

• Garlic

• Spicy foods

• Cabbage

• Broccoli and cauliflower

• Asparagus

• Turnip

• Strong cheese

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Food that may thicken stools • Applesauce

• Bananas

• Cheese

• Marshmallows

• Pasta

• Smooth peanut butter

• Barley

• White rice

• Tapioca

• Yogurt

• Pretzel

• Potato chips

• Oat products

Food & beverages that loosen stools

• Alcohol

• Raw fruits

• Grape and apple juices

• Green beans

• prunes / prune juice

• Spicy poor fried foods

• High-sugar foods

• Spinach

• coffee

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Lifestyle Modification

• Bathing – Bathe/shower with the entire

appliance on, or off on days due for change.

– Water or soap will not damage your stoma; just rinse the soap off thoroughly.

– Do not let water fall directly on your stoma

– Hot/warm tubs allowed but long soaks in it may lessen the normal wear time of the appliance and may need more frequent change

Lifestyle Modification

• You can resume activities like before. – Always carry extra set of appliances when going out.

• Exercise – Can continue exercise and be active in sports as before

– The ostomy does not in itself prevent you from exercises but depends on whether you feel fit

• Clothing – ostomy appliance will

likely not be obvious under your clothing.

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