Stoma Nursing is a specialisation that cares for individuals with stomas, both before and after getting it. This article will explain what a stoma is and what you should be looking out for as a nurse. If you’de like to know how to properly Assess and Manage a Stoma Click Here.
What is a stoma?
Stoma refers to an ‘opening’, so a stoma surgery creates a small opening on the surface of the abdomen. This opening creates a new passage for faeces or urine, and the waste is then collected into a pouch. Such surgeries may be indicated for several reasons including disease, trauma or birth defects.
You can tell if the stoma is healthy by its colour and shape; It should look like a spout or rosebud with a pink and moist colour (similar to the inner layer of the mouth). Most importantly, there are no nerve endings on stomas, so the patient won’t feel anything when touching the stoma.
The waste coming from the stoma will be different depending on its location. A stoma that is closer to the rectum will have hard formed stools, while a stoma that is further up will have looser stools.
There are three main types of stomas:
– Colostomy and Ileostomy which excrete faecal matter
– Urostomy which excretes urine.
With a colostomy, the surgeon creates an opening from the colon (large intestine). Most of the time, this is done to relieve an obstruction (blockage) caused by colon cancer or injuries. The colostomy is usually placed on the left side of the abdomen, and solid stools are expected. It can be performed in two ways:
During an End Colostomy, the surgeon removes the affected part of the colon or rectum. The rest of the colon is then lifted to skin level, and a stoma is created. Such a stoma can be either temporary or permanent depending on the extent of damage to the colon
The technique used in a Loop Colostomy is in its name. Here the surgeon will raise a loop of the bowel (colon) to the skin level, and secure it with a stoma rod. Once the loop is established, an incision is done on it to create a ‘hole’. From there, the edges of this hole are pulled down and sewn to the skin.
A loop colostomy is mostly done in patients who require a temporary stoma.
An ileostomy is when the surgeon creates an opening from the ileum (small bowel). In most cases, this is done to treat ulcerative colitis or to relieve obstruction caused by cancer or trauma.
Given that an ileostomy is most commonly placed over the right side of the abdomen, liquid stools are expected. This surgery can be done in two ways:
During an End Ileostomy, the surgeon uses the last part of the ileum to create a stoma. The aim behind this surgery is to allow the colon to rest (temporary stoma) or to enable the body to function without a colon (permanent stoma).
A loop ileostomy is when the surgeon pulls a loop of the ileum over the skin and secures it with a rod. Once secure, an incision is made on the loop, and the ends are sewn to the skin.
This surgery is most commonly performed for temporary ileostomies.
Stoma Nursing Alerts
Stoma surgery is considered to be a major surgery, mainly because the intestines are very sensitive, and they take time to regain function after the surgery. On top of that the surgery alters the body image, and several patients experience difficulties to accept their new self. So as a nurse you should focus on the following:
The Medical-Surgical Side of Stoma Nursing
The nursing assessment is based on the stoma development and how it is affecting the patient. Make sure to note any changes in the following:
Size of the stoma
Shape of the stoma
Colour of the stoma
Bleeding from stoma or around
Output of the stoma
Skin integrity around the stoma
Nutritional balance of the patient
Checkout the full Stoma Nursing Assessment to learn in more detail.
Several patients will find it difficult to accept their new image with the stoma. Some might even refuse to look at the stoma or participate in the stoma care. Thus, it is extremely important that you help your patient to build up confidence and to feel comfortable with having a stoma.
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