Peristomal Skin Conditions Flashcards
Peristomal skin
Thicker w/ + TEWL
Warm and moist = + vulnerability to pathogens
Moisture = -regional blood flow
Peristomal MASD
Irritant dermatitis, maceration, pseudoverrucous lesion
Chronic = hyperkeratosis and scarring = stoma stenosis
Most common w/ urostomy
Maceration
+ susceptibility to friction and irritation
Most common w/ urostomy
Ensure proper sizing of pouch
Use convexity
Night drainage bag
Dry pouch w/ hairdryer after shower/swimming
Pseudoverrucous lesions
Wart-like Occurs w/ pooling of urine/stool Alkaline crustations if urine alkaline and concentrated Associated w/ UTI and renal calculi Itching, bleeding, erosion, tenderness Use silver nitrate and apply dilute vinegar - urine pH (+ fluid, cranberry juice) Stoma powder to absorb moisture
Pressure Ulcers
Most common if peristomal hernia
2nd to convexity use
Partial or full thickness
Allergic Contact Dermatitis
Erythema w/ blisters
Spreads beyond orig contact area
Topical corticosteroid spray
Stoma powder to absorb moisture
Fungal/Candidiasis Infection
+ w/ recent antibiotics or if immunosuppressed, DM, corticosteroid, chemo
Begins @ moist area
Topical antifungal w/ barrier film
Folliculitis
Inflammation 2nd to injury/infection
Red pustules around follicle
Clip hair or electric razor, depilatory, baby powder
- freq of shaving
Antibacterial soap, topical antibiotic gel
Varices
Portal HTN = enlarged venous channels where + pressure meets - pressure
2nd to cirrhosis and primary sclerosing cholangitis
Bluish or raspberry-like stoma
Spontaneous bleeding w/ visible skin changes
Varices: Treatment
Apply pressure and use silver nitrate
Use barrier film wipe and 1 piece pouch
0 extended-wear skin barrier
0 convexity or belts
0 rubbing of pouch against mucocutaneous junction
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Beta-blocker or embolization of vessels
Granuloma
Juncture of stoma and peristomal skin Immunologic response to foreign material (sutures) Raised, red bumps Bleeding Firm or fluid filled Probe for retained material Silver nitrate to raised areas Stoma powder and foam dressing Convexity
Peristomal Abscess: Acute
w/i 2 wks of stoma creation
Purulent material beneath skin 2nd to foreign body (suture), disease process, or infection
Peristomal Abscess of Established Stoma
2nd to IBD or pyoderma gangrenosum
Peristomal abscess: tx and s/s
Localized redness, swelling, tenderness
Systemic signs of infection possible
Drain fluid, local wound care, systemic antibiotics
+ pouch changes
Pyoderma Gangrenosum
Neutrophilic dermatitis
Recurrent, painful ulcerations
= presence of systemic disease (IBD, arthritis, hematologic disorders)
Pathergy
Partial or full-thickness wounds once ulcers open
Dark w/ irregular borders
Purulent exudate
