Stoma modules caring for the stoma patient

Presenter: AlasdLiz Danfald
Date: 04/11/2007
Target Audience: All

1. Liz Dannfald BSc
CNS Stoma Care
Southern General Glasgow

2. Caring for the Stoma Patient

3. 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

4. What is a stoma?
Stoma is Greek for mouth or opening
The most commonly formed stomas are
Colostomy
Ileostomy
Urostomy

5. Colostomy – large intestine

6. Ileostomy – small intestine

7. Urostomy - ileal conduit

8. Types of stomas
Bowel or urinary
Temporary or Permanent
A Loop or an End
Elective or Emergency

9. 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

10. 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

11. Some more conditions
Spinal Injuries
Incontinence
Constipation
Bladder Cancer
Interstitial Cystitis
Congenital Malformation
Radiation Damage

12. 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

13. Pre-operatively
Information and literature given
Shown appliances
Stoma siting
Offer voluntary visitor
These patients may be emergency or elective

14. 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

15. Appliances
One-piece
Two-piece
Drainable
Closed
Tap
Clear
Opaque
Convex

16. Choice of appliance
Depends on
Type of effluent
Physique of patient
Potential for skin problems
Physical dexterity
Patient preference

17. Accessories
Belts
Adhesive Strips
Cohesive Seals
Convex Rings
Adhesive
Removers
Skin Protectors
Fillers/Pastes
Deodorising Sprays
Gell Capsules

18. 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

19. 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

20. Common problems
Parastomal hernia
Skin problems
Constipation
High Output
Diarrhoea
Excess flatus
Stenosis
Bleeding
Prolapse

21. 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.