301 Stoma Care Flashcards
What is an ostomy?
Opening in abdomen
Bring internal organ to surface during operation
GI or urinary tract
What is a gastrostomy?
For long term enteral feeding/venting or draining of stomach
What is a stoma?
End of intestine that is sewn into ostomy
Types of ostomy: permanence
Temporary (major GI surgery or Crohn’s disease to give bowel rest) or permanent
Types of ostomy: system
Urinary tract (urostomy/ureterostomy more common to be temporary, before or after the bladder)
GI tract (ileostomy/colostomy, more permanent)
Types of ostomy: stoma
End (always permanent, as rest of bowel has been removed) or
Loop (temporary, allow fluids/solid to come out, aim to repair and put back into body)
Spout or flat
What consists of a loop stoma?
Regular stoma (flows faeces) (upstream from mouth)
Shunt between ‘holes’
Mucous fistula (downstream towards anus)
Why is a “brooked” spout used more in GI ostomy and flat in colostomy?
Ileostomy is more liquid than a colostomy more solid
What are the 4 typical positions of colostomy?
- Ascending
- Transverse
- Descending
- Sigmoid
What is a colostomy?
Output
Bag used
Pouch changes
Formed from large bowel
Permanent or temporary
Loop or end stoma
Output formed/soft faeces
Use a closed bag
Pouch change depends on bowel function (2-3x a day)
Difference in sigmoid and ascending colostomy positions
Sigmoid 1-2 bag empties a day as like normal bowel
Ascending 3x due to more watery output produced
What is an ileostomy?
On which side
Output
Bag used
Bag changes
Formed from ileum
On R side
Temporary or permanent
Loop or end, spouted (2.5cm)
Loose, porridge like consistency
Drainable bag
Empty 4-6x a day and change bag on alternate days
Why do ileostomies have a 2.5cm spout?
Acid contents leaking and causing skin irritation otherwise
What is urostomy (ileal conduit)?
Always what?
What does it contain
Pouch type
Bag empties
Bag changes
Formed from section of bowel used to form conduit into where ureters are attached
Permanent, end stoma
Urine always contains mucus
Pouch with tap
Empty 5-6x a day
Bag change alternate days
Types of ureterostomy
Always what?
Pouch type
Bag empties
Bag changes
Single, bilateral, double barrelled, transuretro
Permanent, end stoma
Pouch with tap
Empty 5-6x a day
Bag change alternate days
Types of stoma: colostomy (descending)
Output
Frequency
Stoma
- Solid & flatus
- Intermittent
- Flat
Types of stoma: colostomy (transverse)
Output
Frequency
Stoma
- Formed with flatus
- Continuous
- Flat
Types of stoma: colostomy (ascending)
Output
Frequency
Stoma
- Semi solid
- Continuous
- Flat
Types of stoma: ileostomy
Output
Frequency
Stoma
- Semi liquid
- Continuous
- Spout
Types of stoma: urostomy/ureterostomy
Output
Frequency
Stoma
- Liquid
- Continuous
- Spout
Why do we not have flatus in ascending colostomy or ileostomy?
Gut bacteria are predominantly in end of colon (transverse and descending) not at the start, gut bacteria feed on the fibre
Reasons for a stoma
- Carcinoma (bowel & bladder)
- Diverticulitis
- IBD
- Familial polyposis
- Trauma
- Neurological damage (M.S.)
- Incontinence
- Congenital disorders
Problems with stomas
Stoma management
Skin conditions
Psychological issues
Ischaemia and necrosis in stomas
Poor oxygen perfusion can cause necrosis
Retraction and stenosis in stomas
Lose/gain weight can pull bowel back into body, problem then collecting output
Prolapse of stoma
Bowel is pushed out, changes to body shape and mass or surgical failure can cause
Herniation of stoma
Inside body can push through muscular structure (especially after pregnancy and damage during surgery)
Skin problems in stomas:
Due to?
How common?
Result of?
- Poor stoma sitting
- 1/3 colostomy, 2/3 ileostomy
- Chemical dermatitis or frequent appliance changes, fungal irritation by C.Albicans
- Possible abscess or fistula
Stoma good fit cycle:
Healthy Skin
Leakage
Skin barrier adherence
Mechanical trauma
- -
- Causes poor adherence & leads to unhealthy skin
- Reduced adherence impacts skin health
- Repeated barrier removal & adherence leads to unhealthy skin
Psychological impacts
- Lose self-esteem
- Change in body image
- Loss of confidence
- Social recluse
- Affecting work, relationships, social activities/holidays
- Regular support especially in early recovery period vital
Types of stoma bag:
Closed
Open
Two-piece
Mini pouches
Plugs
- 1 piece, take whole bag off to change
- 1 piece, clip opens to empty
- Skin barrier with flange, bag can unclip from flange
- For swimming, smaller so can engage in activity
- Go on end of descending and sigmoid colostomies to block
Urostomy bag
Open by tap at the bottom
Many patients scared of tap opening
Additional items on drug tariff for stomas
Adhesive remover, barrier wipes/spray/cream, protective paste, filler paste, flange extenders, belts. deodorant, filter covers, measurement guides, support garments, covers, mini pouches, plugs
General advice for colostomy
No dietary restrictions
Eat regular meals
Drink plenty fluids (water, squash, tea, coffee, milk)
Aim for 8-10 cups/mugs daily
How to prevent constipation in colostomy?
Increase fibre intake
Gradually increase fruit and veg to 5 a day
Add Bran to meals (2tsps)
Increase fluid intake (water, squash, fruit juice)
Gentle exercise
Ileostomy advice:
Fluid intake
Food intake
- Good salt intake to prevent dehydration
8-10 large cups/mugs a day (water, squash, tea, coffee, milk) - Spicy foods may cause diarrhoea
High fibre may cause blockage (celery, dried fruit, nuts, coconut, mushrooms, fruit skins, sweetcorn)
Chew well - peel fruit before eating
What to avoid in dietary requirements for stomas?
Veg known for offensive odour (radish, cabbage, garlic, cucumber, kno-kol)
Carbonated drinks
Chewing gum (takes in air)
Smoking
High & moderate fibre diet
Ethical and cultural considerations with a stoma
Skin colour
Diet
Religious fasting
Community pharmacy ostomist services
- Offer delivery of specified (stoma) appliances
- Stoma Appliance Customisation (SAC)
- Appliance Use Review (AUR)
