Stoma Nursing is a specialised branch of nursing that cares for individuals with a stoma. If you’d like to learn more about what a stoma is, and the different types of stomas you should read: Stoma Nursing Guide: Ileostomy & Colostomy
Stomas are becoming more and more popular, mainly because of its endless benefits in improving the quality of life and extending life expectancy. People with ulcerative colitis or colon cancer would have previously lived short, complicated lives, but thanks to the stoma invention, they can easily lead a healthy independent life.
Knowing how to care for and assess stomas effectively is extremely important, especially in the early post-operative stages. Here you will not only be the patient’s medical caregiver, but you are also their educator. But don’t worry if you don’t know how yet. Because this article will guide you through the 6 nursing steps when caring for patients with a fresh stoma.
Stoma Nursing Assessment in 6 Steps
1. The Site
To carry out your assessment correctly, you must first identify what type of a stoma that patient has. Stomas on the left usually indicate colostomies, while stomas on the right often indicate ileostomies.
2. Size and Shape
The size and shape of the stoma will vary from one patient to another, and according to the procedure. A healthy stoma will protrude slightly over the skin level and have a round or oval shape. With regular assessment, you should be able to detect any increase or decrease in size.
An enlarged (prolapsed) stoma can be the result of weight gain, fluid build-up, or increased abdominal pressure caused by coughing. Close monitoring is necessary, as prolapsed stomas may become obstructed and cause constipation. A stoma is considered retracted when it becomes flat or below skin level. This could be a result of surgery difficulties, weight gain, scar tissue or infection. A retracted stoma might cause leaks, and in turn, lead to breaking down of the skin. Choosing the right supplies will help to push out the stoma. Try adopting a convex wafer, ostomy belt or barrier ring and encourage your patient to check for leakages regularly. In the meantime, make sure to inform the surgeon as if the retraction gets worse, the stoma might need to be re-sited.
A healthy stoma should have a bright red or pink colour and a moist surface, like the inner lining of the mouth. Any discolouration or darkening of the colour usually indicates a lack of blood supply or infection. In that case, ensure that the wafer or bag are not putting any pressure on the stoma, and inform the doctors looking after the patient.
In immediately post-operative patients, you should be looking for gas in the stoma bag. Gas is a sign that the bowels are working. Faeces are expected to be very loose in the first stage, especially if the patient has an ileostomy. The colon is responsible for absorbing water as the faeces move towards the rectum. So the consistency of faeces will depend on the location of the stoma. A liquid form is expected towards the ileum while a more solid form is expected closer to the rectum.
Pro-tip: Make sure to choose the right bag depending on the type of output that the patient has. Choose a drainable bag for loose stools and a clip bag for formed stools.
Most stoma surgeries involve partial or full removal of the colon; this means that the patient will not be absorbing electrolytes adequately. So, it is crucial to ensure that the patient is having an adequate intake, especially foods that are high in potassium and sodium.
Encourage your patient to eat and drink regularly and explain that they should not aim to reduce the stoma function by restricting their diet.
6. Skin integrity
The stoma output and regular wafer changes could irritate the skin surrounding the stoma. So taking a few measures to maintain the skin’s integrity can go a long way.
Make sure to use the right size of the wafer and bag.
Make use of ‘washers’ in small stomas and cut as close to the patient’s stoma shape as possible.
Convex wafers are ideal for retracted stomas, or leaking stomas.
Change your patient’s wafer on alternate days and the bag daily.
Clean the skin with water and mild soap, and dry thoroughly before applying new wafers.
Look out for potential allergies, and use different materials.
Going through these 6 steps should give you a full evaluation of the stoma. Nevertheless, do not be shy to ask for help when you come across some unusual stoma complications.
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