Which information would the nurse provide a client with a new colostomy about managing the appliance

02 September 2021

Volume 30 · Issue 16

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

Being a community bladder and bowel nurse on a Crown dependency island with around 250 ostomates brings its own challenges. Ostomates on the Island suffer the same complications and frustrations as ostomates do worldwide. Evidence suggests that 20% of stoma patients found the anxiety of having a stoma affected their personal and work life (Black and Notter, 2021). Stoma-related complications such as parastomal hernias, stenosis, prolapse, and retraction are thought to affect up to 70% of ostomates (Ambe et al, 2018), with many of these issues leading to leakage and sore peristomal skin, which are complications in their own right and which can have a subsequent effect on the ostomate's quality of life.

In the author's day-to-day practice, the most frequent request for stoma advice and support is from ostomates who have sore skin or who have been struggling with leaks. The initial assessment involves the size and position of the stoma and the condition of the abdominal wall. Often the stoma has not been measured for some time and the flange no longer fits around it effectively. There are many causes of leakage and sore peristomal skin, including suboptimal product selection. Local ostomates do not get to see new products as easily as their mainland counterparts, due to there being fewer open days and less opportunity for stoma company territory managers to visit. Often patients try to manage leakage with a variety of samples of devices and skin care products that they have obtained themselves from the internet or by contacting a stoma care company.

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References

Association of Stoma Care Nurses UK. ASCN stoma care. National clinical guidelines. 2016. https://tinyurl.com/y9q295fu (accessed 30 November 2020)

The Royal Marsden manual of clinical nursing procedures, 10th edn. In: Lister S, Hofland J, Graton H (eds). Oxford: Wiley Blackwell; 2020

Royal College of Nursing. Bowel care: management of lower bowel dysfunction, including digital rectal examination and digital removal of faeces. 2020. https://tinyurl.com/y4fu89vn (accessed 1 December 2020)

02 December 2020

Volume 29 · Issue 22

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Several diseases and operations may necessitate the need for the formation of a stoma. Patients who are affected may be concerned about the effect of the stoma on their ability to carry out activities of daily living, as well as how it will affect their quality of life. Nurses who may be involved in the care of patients with a stoma should have an understanding of the reasons for stoma formation, and the types of stoma and appliances available, to enable them educate and support patients, and to allay any concerns.

There are about 120 000 people living with a stoma in the UK, with about 25 000 new stoma operations (ostomies) taking place each year. In 2017, there were about 11000 new colostomies, 9000 new ileostomies and 1660 new ileal conduits created (Lister et al, 2020). The most common underlying conditions resulting in the need for stoma surgery are listed in Box 1.

Major causes:

Other causes for stoma surgery include:

A stoma, which it is an artificial opening on the abdomen to divert flow of faeces or urine into an external pouch that is located outside of the body, can be temporary or permanent. Colostomy and ileostomy are the most common forms of stoma (Figure 1), but a gastrostomy, jejunostomy, duodenostomy or caecostomy may also be performed. Understanding the type and extent of surgical intervention in each patient is crucial in managing the patient's nursing needs correctly. It is important to recognise that, once a stoma has been formed, the patient (ostomate) will require an appliance that attaches to the abdomen to collect and dispose of the elimination products.

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