Basic stomatherapy

Question 1

What is the ostomates bill of rights

Answer 1

The ostomate shall:

• Be given pre-op counselling
• Have an appropriately positioned stoma
• Have a well- constructed stoma
• Have a skilled postop nursing care
• Have emotional support
• Have individual instruction
• Be informed on the availability of supplies
• Be provided provided with information on the community resources
• Have a post hospital follow up and lifelong supervision
• Benefit from team efforts of healthcare professionals
• Be provided with information and counsel from the ostomy association and its members

Question 2

What is the purpose of a temporary stoma

Answer 2

To assume the function of elimination of waste, to permit healing or rest the gut or section of bowel

Question 3

What is the purpose of a permanent stoma

Answer 3

To take over the function of elimination of the bowel that has been removed or permanently bypassed

Question 4

What are three classifications of stomas and examples of each

Answer 4

• Input stomas eg gastrostomy, jejunostomy
• Diverting stomas eg ileostomy/ loop colostomy
• Output stomas eg bladder/ bowel

Question 5

Indications for stoma surgery

Answer 5

• Congenital: Ano-rectal malformation/ oesphageal atresia/ Ectopia vesicae
• Acquired: Radiation fistula secondary to radiation fibrosis/ radiation enteritis/ vesico vaginal/ recto vaginal fistulae
• Traumatic: gunshot wounds/ stabs/ MVA
• Infective: Inflammatory bowel disease/ diverticulitis/ interstitial cystitis
• Neoplastic: Carcinomas of the bowel/ bladder

Question 6

Most commonly created output stomas

Answer 6

• Faecal: Colostomy and ileostomy

- Urinary: Ileal conduit/ Urostomy and nephrostomy

Question 7

Name the types of colostomies

Answer 7

• End Colostomy
• Loop colostomy
• Divided colostomy
• Double barrel/ Mikulicsz

Question 8

What does one need to know before siting a patient?

Answer 8

• Provisional diagnosis
• The planned incision
• Proposed stoma
• The stomatherapist will always sit, stand and lie the patient to obtain the most appropriate site
• Factors taken into consideration: Locate the rectus muscle, ascertain the waistline/ beltline; ascertain the hobbies, work, sports and activities of the patients

Question 9

What should one avoid when siting a patient

Answer 9

• Lower costal margins
• Planned incisions
• Old scars
• Obvious creases
• Umbilicus
• Iliac crests

Question 10

Factors influencing stool frequency and consistency

Answer 10

• Site in the colon
• Precipitating condition or disease process
• Previous surgery to the GIT tract
• radiotherapy and chemotherapy
• Medication
• Physical status
• Eating and drinking habits

Question 11

What parameters does one look at when assessing a stoma

Answer 11

• Stoma viability
• Size- measure the diameter
• Skin- check the condition of the peristomal and parastomal skin
• Effluent faeces or urine
• Stool consistency
• Financial consideration
• Ostomate’s ability to manage
• Availability of the product

Question 12

Describe the ideal colostomy

Answer 12

-Healthy pout of 1 cm (mobilise to 2cm and evert to 1cm)

Question 13

Describe the ideal ileostomy

Answer 13

Healthy spout of 3 cm (Mobilise to 6 cm and evert to 3cm)

Question 14

Dermatological complications of a stoma

Answer 14

• Faecal contamination
• Adhesive pouch / tape allergy
• Mechanical
• Bacterial/ fungal

Question 15

Surgical complications of a stoma

Answer 15

• Parastomal hernia
• Stenosis: cutraneal or deep fascial
• Retraction
• Prolapse
• Peristomal granulation
• Bolus obstruction
• Stoma separation
• Ischaemia