Stoma Care oxford Flashcards
1
Q
Principles of ostomy care
A
- independence encouraged
- deline of function - pouching systems simplified
- Caregivers may need to be involved. Preferably one that patient chooses
2
Q
Definition of peristomal plane
A
- Area under solid skin barrier and tape of pouching system
- extending out 4 inches from base of stoma
3
Q
Palliative Ostomy Surgery - indications
A
- decompression of bowel obstruction
- diversion
- proximal to perforation, obstruction, rectovaginal, rectovesicular, enterocutaneous fistula
- pelvic radiation
4
Q
How can one maintain independence in ostomy care?
A
- drainable pouches with velcro, clips
- pre cut, moldable skin barriers
- closed ended disposable pouches
- one piece systems
- two piece systems with adhesives instead of flanges
5
Q
How to help caregiver who needs to take over ostomy care?
A
- plan with patient
- person should be preferred by patient, and capable to learn
- early education
- consider simplified care
6
Q
Risks to peristomal health
A
- leakage can damage skin
- weight loss
- ascites
- varicosities
- tumour growth
7
Q
Basic principles of pouching in ostomy (Skin barriers)
A
- Skin barrier to protect peristomal skin from effluent
- Pouch to contain effluent
- Stoma opening in skin barrier should be same size and shape of stoma (no greater than 0.3cm larger than stoma)
- skin barrier type chosen on type of effluent (liquid feces, formed stool, urine)
8
Q
When to choose firm pouching system
A
- useful for soft or flabby peristomal skin
9
Q
When to choose flexible pouching system
A
- adhesive, no flange
- useful if peristomal plane is round, firm, or protrudes
10
Q
When to use convex skin barriers / pouching system
A
- Convex skin barriers improve seals when stomas have retracted below skin level.
- Fill scarring, folds, creases
- retracted or flsuh stoma
- Avoid if mucocutaneous separation - may worsen
11
Q
Managing uneven peristomal area
A
- use barrier pastes
- fill in defects and uneven areas
12
Q
How to assess skin barrier during changes
A
- Assess for hidden leaks
- Effluent on skin barrier
*
13
Q
Risk of stoma and peristomal complications
A
- advanced disease
- newly created stomas
- high risk of mucocutaneous separation or retraction
- caput medusa (varicosities peristomal secondary to portal hypertension)
- hernia
- prolapse
- irritant dermatitis
- candidiasis
- prior radiation
14
Q
Management of stomal retraction
A
- stoma is pulled below skin level
- pouching options and adjustments for a good seal help
- convexity, supprt belts, binders
15
Q
Definition and management of mucocutaneous separation
A
- detachment of stoma from peristomal skin (partial or circumferential, superficial or deep)
- precedes retraction
- conservative mx
- separation filled with dressing
- skin barrier over filled area to protect it
- monitor for stenosis and retraction
- surgery if separated below fascia
