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301 Stoma Care Flashcards

(41 cards)

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1
Q

What is an ostomy?

A

Opening in abdomen
Bring internal organ to surface during operation
GI or urinary tract

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2
Q

What is a gastrostomy?

A

For long term enteral feeding/venting or draining of stomach

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3
Q

What is a stoma?

A

End of intestine that is sewn into ostomy

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4
Q

Types of ostomy: permanence

A

Temporary (major GI surgery or Crohn’s disease to give bowel rest) or permanent

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5
Q

Types of ostomy: system

A

Urinary tract (urostomy/ureterostomy more common to be temporary, before or after the bladder)
GI tract (ileostomy/colostomy, more permanent)

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6
Q

Types of ostomy: stoma

A

End (always permanent, as rest of bowel has been removed) or
Loop (temporary, allow fluids/solid to come out, aim to repair and put back into body)
Spout or flat

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7
Q

What consists of a loop stoma?

A

Regular stoma (flows faeces) (upstream from mouth)
Shunt between ‘holes’
Mucous fistula (downstream towards anus)

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8
Q

Why is a “brooked” spout used more in GI ostomy and flat in colostomy?

A

Ileostomy is more liquid than a colostomy more solid

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9
Q

What are the 4 typical positions of colostomy?

A
  1. Ascending
  2. Transverse
  3. Descending
  4. Sigmoid
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10
Q

What is a colostomy?
Output
Bag used
Pouch changes

A

Formed from large bowel
Permanent or temporary
Loop or end stoma
Output formed/soft faeces
Use a closed bag
Pouch change depends on bowel function (2-3x a day)

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11
Q
A
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12
Q

Difference in sigmoid and ascending colostomy positions

A

Sigmoid 1-2 bag empties a day as like normal bowel
Ascending 3x due to more watery output produced

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13
Q
A
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14
Q

What is an ileostomy?
On which side
Output
Bag used
Bag changes

A

Formed from ileum
On R side
Temporary or permanent
Loop or end, spouted (2.5cm)
Loose, porridge like consistency
Drainable bag
Empty 4-6x a day and change bag on alternate days

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15
Q

Why do ileostomies have a 2.5cm spout?

A

Acid contents leaking and causing skin irritation otherwise

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16
Q

What is urostomy (ileal conduit)?
Always what?
What does it contain
Pouch type
Bag empties
Bag changes

A

Formed from section of bowel used to form conduit into where ureters are attached
Permanent, end stoma
Urine always contains mucus
Pouch with tap
Empty 5-6x a day
Bag change alternate days

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17
Q

Types of ureterostomy
Always what?
Pouch type
Bag empties
Bag changes

Study These Flashcards
A

Single, bilateral, double barrelled, transuretro
Permanent, end stoma
Pouch with tap
Empty 5-6x a day
Bag change alternate days

18
Q

Types of stoma: colostomy (descending)
Output
Frequency
Stoma

Study These Flashcards
A
  1. Solid & flatus
  2. Intermittent
  3. Flat
19
Q

Types of stoma: colostomy (transverse)
Output
Frequency
Stoma

Study These Flashcards
A
  1. Formed with flatus
  2. Continuous
  3. Flat
20
Q

Types of stoma: colostomy (ascending)
Output
Frequency
Stoma

Study These Flashcards
A
  1. Semi solid
  2. Continuous
  3. Flat
21
Q

Types of stoma: ileostomy
Output
Frequency
Stoma

Study These Flashcards
A
  1. Semi liquid
  2. Continuous
  3. Spout
22
Q

Types of stoma: urostomy/ureterostomy
Output
Frequency
Stoma

Study These Flashcards
A
  1. Liquid
  2. Continuous
  3. Spout
23
Q

Why do we not have flatus in ascending colostomy or ileostomy?

Study These Flashcards
A

Gut bacteria are predominantly in end of colon (transverse and descending) not at the start, gut bacteria feed on the fibre

24
Q

Reasons for a stoma

Study These Flashcards
A
  1. Carcinoma (bowel & bladder)
  2. Diverticulitis
  3. IBD
  4. Familial polyposis
  5. Trauma
  6. Neurological damage (M.S.)
  7. Incontinence
  8. Congenital disorders
25
Problems with stomas
Stoma management Skin conditions Psychological issues
26
Ischaemia and necrosis in stomas
Poor oxygen perfusion can cause necrosis
27
Retraction and stenosis in stomas
Lose/gain weight can pull bowel back into body, problem then collecting output
28
Prolapse of stoma
Bowel is pushed out, changes to body shape and mass or surgical failure can cause
29
Herniation of stoma
Inside body can push through muscular structure (especially after pregnancy and damage during surgery)
30
Skin problems in stomas: Due to? How common? Result of?
1. Poor stoma sitting 2. 1/3 colostomy, 2/3 ileostomy 3. Chemical dermatitis or frequent appliance changes, fungal irritation by C.Albicans 4. Possible abscess or fistula
31
Stoma good fit cycle: Healthy Skin Leakage Skin barrier adherence Mechanical trauma
1. - 2. Causes poor adherence & leads to unhealthy skin 3. Reduced adherence impacts skin health 4. Repeated barrier removal & adherence leads to unhealthy skin
32
Psychological impacts
1. Lose self-esteem 2. Change in body image 3. Loss of confidence 4. Social recluse 5. Affecting work, relationships, social activities/holidays 6. Regular support especially in early recovery period vital
33
Types of stoma bag: Closed Open Two-piece Mini pouches Plugs
1. 1 piece, take whole bag off to change 2. 1 piece, clip opens to empty 3. Skin barrier with flange, bag can unclip from flange 4. For swimming, smaller so can engage in activity 5. Go on end of descending and sigmoid colostomies to block
34
Urostomy bag
Open by tap at the bottom Many patients scared of tap opening
35
Additional items on drug tariff for stomas
Adhesive remover, barrier wipes/spray/cream, protective paste, filler paste, flange extenders, belts. deodorant, filter covers, measurement guides, support garments, covers, mini pouches, plugs
36
General advice for colostomy
No dietary restrictions Eat regular meals Drink plenty fluids (water, squash, tea, coffee, milk) Aim for 8-10 cups/mugs daily
37
How to prevent constipation in colostomy?
Increase fibre intake Gradually increase fruit and veg to 5 a day Add Bran to meals (2tsps) Increase fluid intake (water, squash, fruit juice) Gentle exercise
38
Ileostomy advice: Fluid intake Food intake
1. Good salt intake to prevent dehydration 8-10 large cups/mugs a day (water, squash, tea, coffee, milk) 2. Spicy foods may cause diarrhoea High fibre may cause blockage (celery, dried fruit, nuts, coconut, mushrooms, fruit skins, sweetcorn) Chew well - peel fruit before eating
39
What to avoid in dietary requirements for stomas?
Veg known for offensive odour (radish, cabbage, garlic, cucumber, kno-kol) Carbonated drinks Chewing gum (takes in air) Smoking High & moderate fibre diet
40
Ethical and cultural considerations with a stoma
Skin colour Diet Religious fasting
41
Community pharmacy ostomist services
1. Offer delivery of specified (stoma) appliances 2. Stoma Appliance Customisation (SAC) 3. Appliance Use Review (AUR)

Pharmacy 301 (23 decks)

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