4.12 Stoma therapy in PC

Question 1

Pouching of a stoma can change over time. What are four issues occurring in the palliative setting that may impact how well a pouch fits onto a stoma?

Answer 1

weight loss or gain

ascites

tumor growth

varicosities

Question 2

As disease progresses stomas can be adversely affected. List 4 issues that can arise with stomas and 2 conditions that commonly affect the peristomal skin

Answer 2

Complications:

• mucocutaneous separation
• retraction
• caput medusa - of the stoma
• prolapse
• hernia

Skin conditions:
peristomal irritant dermatitis
candidiasis

Question 3

A patient you are caring for has end stage cirrhotic liver disease with portal hypertension. This patient has a stoma which has developed peristomal varices and they begin to bleed. This three interventions for the management of bleeding

Answer 3

pressure
cold cloth
topical hemostatic agents (silver nitrate, thrombin)
sutures

Question 4

List four risk factors that increase the chance of complications in the palliative setting

Answer 4

previous radiation
immunocompromise
poor nutrition
liver disease

Question 5

A patient you are caring for has a history of right sided colon cancer with a right sided ileostomy. The patient presents with pain. What types of medications should be avoided in this setting

Answer 5

enteric coated or sustained release products

Question 6

List four risk factors for the development of pressure ulcers in advanced disease

Answer 6

malnourishment
cachexia
dehydration
chair bound or bed bound status
multisystem failure with resultant poor tissue perfusion to skin

Question 7

List three interventions that can be undertaken to prevent the development of pressure ulcers in advanced disease

Answer 7

use of appropriate support surfaces
frequent turning/repositioning
maintaining clean and dry skin
use of skin and positioning products to protect high risk areas

Question 8

Often in the setting of advanced disease cure of a skin wound is not possible. What are four realistic goals of wound care in the palliative setting?

Answer 8

creating a stable wound with relief of pain
eliminating odor
managing drainage
preventing infection
maintaining a person’s optimal level of functioning

Question 9

A patient you are caring for develops a fungating malignant wound with exudate and a foul smell. List four interventions you would recommend to this patient

Answer 9

cleaning the lesion with antibacterial soap and water
applying topical antimicrobials such as metronidazole tabs/gel
using dressings to facilitate autolytic debridement, exudate absorption, and pain management
Honey based dressing