Liz Dannfald BSc

CNS Stoma Care

Southern General Glasgow

Caring for the Stoma Patient

Aim

To give an overview of the role of a Nurse Specialist in Stoma Care

To give an insight of stoma surgery Reasons for stoma formation How to change a stoma appliance

What is a stoma?

Stoma is Greek for mouth or opening

The most commonly formed stomas are Colostomy Ileostomy Urostomy

Colostomy – large intestine

Ileostomy – small intestine

Urostomy - ileal conduit

Types of stomas

Bowel or urinary Temporary or Permanent A Loop or an End Elective or Emergency

Reasons for Stoma Formation

To divert faeces away from a a surgical anastamosis, to allow healing

Removal of or damage to sphincters which control continence

To aid in symptom control where surgery is not possible

Bladder disease

Conditions which may result in stoma formation

Inflammatory Bowel Disease- ( IBD) Crohn’s Disease, Ulcerative Colitis

Colorectal Cancer FAP- Familial Adenomatous Polyposis Diverticular Disease Anal Cancer Trauma

Some more conditions

Spinal Injuries Incontinence Constipation Bladder Cancer Interstitial Cystitis Congenital Malformation Radiation Damage

Role Of The Stoma Nurse

To provide holistic care for patients who require to have a stoma formed

To educate patients/carers/staff in stoma care Wound and fistula management Research and audit Dissemination of information to multidisciplinary

colleagues Time management

Pre-operatively

Information and literature given Shown appliances Stoma siting Offer voluntary visitor

These patients may be emergency or elective

Post-operatively

Patient teaching Preparation for discharge Follow up- House Calls Out –Patient Clinics Liaise with District Nurses and Home Care

Team Nursing Home/Hospice visits

Appliances

One-piece Two-piece Drainable Closed Tap

Clear Opaque Convex

Choice of appliance

Depends on

Type of effluent Physique of patient Potential for skin problems Physical dexterity Patient preference

Accessories

Belts Adhesive Strips

Cohesive Seals Convex Rings

Adhesive Removers

Skin Protectors Fillers/Pastes Deodorising Sprays Gell Capsules

Day To Day Management

Appliances should be emptied/changed regularly

When changing appliance things to get ready New appliance - Cut to correct size Warm Water Disposal Bag Wipes Any Accessories required

To change the appliance

Empty if required Remove soiled appliance Wash and dry stoma and surrounding skin Apply new appliance from bottom up. Dispose of soiled equipment

Common problems

Parastomal hernia Skin problems Constipation High Output Diarrhoea Excess flatus

Stenosis Bleeding Prolapse

Conclusion

Patients who have had stoma surgery can face many physical and psychological challenges. However, with the support of the healthcare team, both in hospital and the community, these challenges can be overcome and the patient can lead a normal lifestyle.