Basic stomatherapy Flashcards
What is the ostomates bill of rights
The ostomate shall:
- Be given pre-op counselling
- Have an appropriately positioned stoma
- Have a well- constructed stoma
- Have a skilled postop nursing care
- Have emotional support
- Have individual instruction
- Be informed on the availability of supplies
- Be provided provided with information on the community resources
- Have a post hospital follow up and lifelong supervision
- Benefit from team efforts of healthcare professionals
- Be provided with information and counsel from the ostomy association and its members
What is the purpose of a temporary stoma
To assume the function of elimination of waste, to permit healing or rest the gut or section of bowel
What is the purpose of a permanent stoma
To take over the function of elimination of the bowel that has been removed or permanently bypassed
What are three classifications of stomas and examples of each
- Input stomas eg gastrostomy, jejunostomy
- Diverting stomas eg ileostomy/ loop colostomy
- Output stomas eg bladder/ bowel
Indications for stoma surgery
- Congenital: Ano-rectal malformation/ oesphageal atresia/ Ectopia vesicae
- Acquired: Radiation fistula secondary to radiation fibrosis/ radiation enteritis/ vesico vaginal/ recto vaginal fistulae
- Traumatic: gunshot wounds/ stabs/ MVA
- Infective: Inflammatory bowel disease/ diverticulitis/ interstitial cystitis
- Neoplastic: Carcinomas of the bowel/ bladder
Most commonly created output stomas
- Faecal: Colostomy and ileostomy
- Urinary: Ileal conduit/ Urostomy and nephrostomy
Name the types of colostomies
- End Colostomy
- Loop colostomy
- Divided colostomy
- Double barrel/ Mikulicsz
What does one need to know before siting a patient?
- Provisional diagnosis
- The planned incision
- Proposed stoma
- The stomatherapist will always sit, stand and lie the patient to obtain the most appropriate site
- Factors taken into consideration: Locate the rectus muscle, ascertain the waistline/ beltline; ascertain the hobbies, work, sports and activities of the patients
What should one avoid when siting a patient
- Lower costal margins
- Planned incisions
- Old scars
- Obvious creases
- Umbilicus
- Iliac crests
Factors influencing stool frequency and consistency
- Site in the colon
- Precipitating condition or disease process
- Previous surgery to the GIT tract
- radiotherapy and chemotherapy
- Medication
- Physical status
- Eating and drinking habits
What parameters does one look at when assessing a stoma
- Stoma viability
- Size- measure the diameter
- Skin- check the condition of the peristomal and parastomal skin
- Effluent faeces or urine
- Stool consistency
- Financial consideration
- Ostomate’s ability to manage
- Availability of the product
Describe the ideal colostomy
-Healthy pout of 1 cm (mobilise to 2cm and evert to 1cm)
Describe the ideal ileostomy
Healthy spout of 3 cm (Mobilise to 6 cm and evert to 3cm)
Dermatological complications of a stoma
- Faecal contamination
- Adhesive pouch / tape allergy
- Mechanical
- Bacterial/ fungal
Surgical complications of a stoma
- Parastomal hernia
- Stenosis: cutraneal or deep fascial
- Retraction
- Prolapse
- Peristomal granulation
- Bolus obstruction
- Stoma separation
- Ischaemia
