What the stoma Clinic Offers at National Hospital and Cancer Research Center, Jawalakhel

Preoperative Services

Counseling:

·         Basic ostomy education and answers to questions such as surgical procedures, living with a stoma, pre- and post-op diets, concerns re: returning to work, etc.

·         Familiarize patients and their families with various types of ostomy appliances and supplies that are available.

·         Assist patients in selecting a reliable pouching system/appliance, keeping their personal needs and choices in mind.

Stoma Site Marking(s):

·         A preoperative assessment of the abdomen is performed to determine the best location for stoma placement (more than one site may be marked).

·         Stoma site marking(s) may be done during an outpatient pre-op visit, in the hospital pre-op holding area, or in a patient’s hospital room.

·         Proper stoma placement helps patients avoid post-op wound and skin complications caused by leakage.

Postoperative Services

Education on Stoma Management:

·         Patients are instructed on self-care, proper hygiene and how to maintain skin health.

·         Along with patients, families and/or caregivers learn proper stoma care to help prevent common problems from occurring.

General WOC Nursing Care:

·         Care coordination and management for patients with a new or existing ostomy, with or without complications.

·         Determine if patient’s current pouching system/appliance is adequate/ reliable and obtain new appliance if it needs to be updated.

·         Assess patient’s clothing and provide recommendations if needed for undergarments, support belts, etc.

·         Arrange for visit(s) by a home health agency prior to patient discharge and work in conjunction with this agency care and staff for a seamless continuum of care.

Problem Solving & Ongoing Support:

·         Provide assistance with pouching system/appliance failures, such as leaks.

·         Refit pouching system/appliance to provide proper seal and optimum comfort as needed.

·         Assist with short-term care and/or long-term management for patients with peristomal skin loss, infections, ulcers, and/or rashes.

·         Ensure that the patient is coping with lifestyle changes, help to alleviate anxieties associated with the ostomy, providing support as needed

Problematic Stomas

Most people are able to live life with a stoma as they did before their surgery. But sometimes problems do arise which can cause concern. Below are some of the most common stoma problems and some hints and tips to help you overcome them.

Ballooning

Ballooning is where gas collects inside the bag causing it to inflate.

Constipation/Diarrhoea

Changes of bowel function resulting in diarrhoea or constipation are common in the normal population - for a colostomate there is no difference, these alterations in bowel function can still occur.

Granulomas

What causes stoma granulomas and how they can be treated

Odour

Odour could mean leakage or the filter may have come into contact with the contents of the bag making the deodoriser ineffective.

Pancaking

This is when the output collects around the stoma and can squeeze between the flange and the skin instead of going into your bag. One of the reasons this happens is because there isn't enough air in the bag and so the output can not tmove down the bag.

Parastomal Hernia

A hernia is a weakness in the wall of the abdomen that allows the contents to bulge out forming a lump or swelling. If the weakness occurs where the stoma is attached to the muscle wall causing a swelling around the stoma, this is called a Parastomal Hernia.

Prolapse

A prolapse is not uncommon and can be found alone or in association with a parastomal hernia.

Rectal Discharge

Many people with a stoma experience discharge from the back passage despite the fact that they have a colostomy.

Rectal Pain

What causes rectal pain?

Sore skin/Leakage

There are many reasons why the skin may become sore, so it is important to know what may be the cause and to know that you can do something to reduce the problem.

Management of frequent leak of ostomy appliance due to uneven skin!!!!!

There is unven skin. The upper part in figure is high but the lower part is depressed that's why the appliances used to leak frequently. 

The adapt barrier ring was applied on the depressed part of peristomal skin and again adapt barrier ring applied round the cut end of flange so that skin becomes even and adhere on to the skin properly. This way of management might be helpful in the same cases of many patients having stoma.

Presentation about ostomy care at Bhaktapur Cancer Hospital

 

 

 

 

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Eakin seal, a solution to many ostomy problems!!!!!

Stoma with depression on right and left side. In this condition eakin can be of great help! In the last picture, eakin seal is molded and kept to maken the depressed skin even so that ostomy appliances will attach longer. Most of the patients in Nepal have problem of frequent leakage from ostomy appliances. There is no trend of visiting to stoma care specialist because unknown about the need. In some cases, even patients know that they have to meet the ostomy nurse but they feel that nurses can not treat the problems like doctors. That means the nurses are not trusted as doctors. Thes two types of factors are playing a great role in proper management of ostomy related problems.

Paediatric ostomy care at a glance

Colostomy created for anorectal malformation.

 

 

 

 

 

 

 

 

 

 

Piece of cloth kept round the stoma to hold stool.

 

Too much skin excoriation after having colostomy for Ano rectal malformation.

 

 

 

 

 

 

 

4 years old boy successfully treated with ostomy powder and colostomy bag due to very excoriated skin exposed to stool( above picture).

 

 11 years old chld wearing a colostomy bag after colonic perforation.

 

 

 

13 years old girl applying colostomy bag after Ano-Rectal malformation. 

Ostomy Bridge

“The Ostomy Bridge can provide a small amount of space between the body and articles of clothing to allow people to wear a functioning ostomy pouch while fully dressed in pants, a shirt, a belt, and other articles of clothing. This innovative product can resemble a belt with a raised attachment piece that can hold a pouch close to the body, allowing the user to put clothes on over it. This product can be ideal for anyone who has ever worried about wearing their pouch while going to work, running errands, or going out other places.”

Stomal marking is important before ostomy surgery.

Loop Ileostomy

 

 

A 26 has a loop ileostomy for hernia with damage some portion of small intestine. His suture line was separated due to infection after 7days of operation.peristomal skin was excoriated and colostomy bag used to leak daily because of oozing blood from excoriated peristomal skin. After visiting him at Teaching Hospital, I applied ostomy powder on the excoriated skin and adapt barrier ring underneath the flange.Then Patient used to change colostomy bag once a week but some times it leaks becase there is the bony prominence near stoma. So the stoma site is not at appropriate site.Frequent leakage of colostomy bag sometimes is related to improper siting of stoma. So it is necessary to consult ostomy nurse to site stoma which will prevent complications.



How to apply colostomy bag on uneven skin

 Depressed stoma after applying ostomy powder over the peristomal skin.

 Adapt barrier ring applied round the stoma to make surrounding skin even

Convex adhesive coupling flange applied over the adapt barrier ring and then pouch is attached.This is the way of providing colostomy care on depressed stoma with uneven skin.