Module 4 - Stomal Therapy

Question 1

Define stoma.

Answer 1

Refers to any surgically constructed opening onto the body surface to facilitate a bodily function.

Question 2

List reasons for stoma formation/

Answer 2

Malignancy
Obstruction
Disease process
Neurological impairment
TraumaTypes

Question 3

Types of stomas.

Answer 3

Colostomy
Ileostomy
Urostomy (Ileal conduit)

Question 4

Define colostomy.

Answer 4

A surgical opening into the large intestine with a stoma created on the abdomen
A colostomy can be:
1. Permanent
2. Temporary

Question 5

Permanent Colostomy - Abdominal-Perineal Resection

Answer 5

• Sigmoid colon, rectum, ischio-rectal tissues and anus removed
• Performed for anal and low rectal cancers

Question 6

Permanent or Temporary Colostomy - Hartmann’s Procedure

Answer 6

- Abdominal excision of Sigmoid Colon
and upper 1/3 of Rectum
- Rectal stump oversewn
- End colostomy (temporary or permanent)
- Performed for disease / trauma / malignancy

Question 7

Temporary Colostomy - Anterior Resection

Answer 7

• Excision sigmoid colon and rectum with surrounding tissues
• Colostomy (temporary) to protect the anastomosis
• Performed for rectal cancers not invading anal sphincters

Question 8

Describe Colostomy Appliances

Answer 8

- One-piece
Closed or drainable appliances
- Two-piece
Closed or drainable appliances
- Colostomy irrigation
No pouch or mini pouch required

Question 9

Define Ileostomy.

Answer 9

• A surgical opening into the ileum with a stoma created on the abdomen
• Stoma is commonly sited in the terminal ileum

Question 10

Describe your colon!

Answer 10

• The large intestine (colon) is 1.5 metres long, from caecum to anus
• The rectum is 17cm long
• The anal canal is 3 cm
• The internal anal sphincter is smooth (involuntary) muscle
• The external anal sphincter is striated (voluntary) skeletal muscle
• Slower mass colonic movements in the left / descending colon reduces the frequency and force of faecal expulsion
• Gas and odour are more marked in the right / ascending colon due to bacterial and enzymatic activity
• Prolonged skin contact with effluent is likely to compromise the skin

Question 11

Describe your ileum!

Answer 11

• The longest part of the small intestine 3.6 metres long
• Provides the most extensive area of digestion and absorption
• Ileal contents (Chyme) are slightly alkaline –pH 7.6
• Prolonged skin contact with effluent is likely to compromise the skin.

Question 12

Indications for permanent ileostomy.

Answer 12

Crohn’s disease
Ulcerative colitis
Familial Adenomatous
Polyposis

Question 13

Describe Temporary Loop Ileostomy

Answer 13

• Performed to rest an anastomosis
• To allow a internal reservoir or pouch to heal
• Ileostomy patients need a drainable appliance as the effluent is fluid

Question 14

Describe a Urostomy or Ileal Conduit. List indications.

Answer 14

An opening into the urinary track with a stoma created on the abdomen.

Indications:

• Malignancy of lower urinary tract
• Intractable interstitial cystitis
• Neurogenic disorders of the bladder
• Trauma to bladder or urethra
• Intractable urinary incontinence
• Problematic suprapubic catheter
• Congenital anomalies

A urostomy or ileal conduit requires a drainable appliance with a non-return value

Question 15

Pre-operative stoma care.

Answer 15

Stomal Therapy Counselling

• Surgical procedure information
• Introduction to living with a stoma
• Skin care, odour, diet and activities
• Appliance options
• Appliance collection
• Trial an appliance

Site the stoma
Routine pre-op care (bowel cleansing, fasting, shave or clip hair, pre-medication)

Question 16

Post-operative stoma care.

Answer 16

Goal is to promote self-care and
rehabilitation
- Observation of the stoma
- Skin care
- Appliance selection & use
- How to obtain their appliances
- Odour control & Flatus
- Disposal of used appliances
- Diet & hydration

Question 17

Stoma observations.

Answer 17

Colour
Sutures
Size
Flatus
Action

Question 18

Stoma skin care.

Answer 18

Remove appliance gently
Cleanse the skin with gentle soap and water
Dry the skin
Shave or clip excess hair if necessary
Use skin protective film barriers if needed
Correctly size aperture

Question 19

Potential stoma problems.

Answer 19

Appliance leakage
Skin ulceration
Muco-cutaneous separation
Peri or para-stomal hernia
Prolapse
Retraction or flush stoma
Stenosis

Question 20

When should stoma bags be emptied?

Answer 20

• Bags should be changed or emptied when 1/3 full

- Over distension of bags will pull on base plate and may cause detachment and leakage