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Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
There are three main types of stoma: Ileal conduit – formed to drain urine into the stoma bag, if the bladder is removed or bypassed.Ileostomy – formed when the whole of the large bowel is removed (liquid stool is collected by the stoma bag).Colostomy – formed when only part of the large bowel is removed (faeces are usually more formed and solid or semi-solid).
Nursing Considerations in Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Margaret Birdsong, Michelle Felix
Complications that may occur can involve the stoma itself, the surgical wound, or the peristomal skin. For ongoing assessment and for communication with other members of the team, we recommend photography, if possible, which can be uploaded to the Media section of the medical record.
Stoma and Its Complications
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
The word stoma (or ostomy) is derived from Greek and means ‘mouth’. It is created by a surgical procedure consisting of forming an aperture in the intestine and placing it on the anterior abdominal wall. This aperture allows the patient to eliminate feces and urine out of the body, and to administer nutritional and therapeutic substances. The stoma can be either intestinal or urinary. Intestinal stoma are either an ileostomy or colostomy. There are both advantages and disadvantages of ileostomies and colostomies, and the choice of stoma is based on the nature of the disease and the morbidities associated with a particular type of stoma. Several predictors of high-risk stomas are studied here, as well as a few techniques – such as identifying compromised vascularity and transanal rectal tube drainage – are described for reducing anastomotic leak rates and thus avoiding the creation of diversion stoma. It is important to understand the appropriate time for reversal of stoma. It depends on disease and treatment factors, and reversal of stoma cannot be attempted too early nor can it be delayed too late.
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
Males with cervical SCI and significant upper extremity dysfunction often depend upon caregivers to perform intermittent catheterizations. Women with SCI may find self-catheterization difficult, not only due to impaired upper extremity function but also due to the challenges of conveniently accessing the female urethra. Unfortunately, tetraplegic women often rely on either an indwelling catheter or the creation of an incontinent urinary stoma. Highly motivated female SCI individuals can be managed successfully by the creation of a continent abdominal stoma which is much more accessible and requires less dexterity to access than the native urethra. Significant and common complications such as stomal stenosis, difficulty with catheterization, and stomal incontinence are reported in up to one-third of adult patients with neurogenic bladder who undergo continent catheterizable stoma creation.16 These high rates of complications make the native urethra the preferred site for intermittent catheterization when practical.
Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction
Published in Scandinavian Journal of Gastroenterology, 2021
Kevin Afshari, Maziar Nikberg, Kenneth Smedh, Abbas Chabok
Having a stoma is associated with morbidity with readmission for dehydration and renal failure [16–18], as well as skin irritation, stomal prolapse, and hernias [18]. In addition, there are studies indicating that timing of stoma reversal within 3 or 6 months, are important for bowel function [19–22]. Nevertheless, many patients have their stomas for a long time before reversal probably because of lack of hospital beds or low priority within the health care system. Within a day case setting, hospital stay is greatly decreased allowing more patients to have their stoma closed sooner, which would reduce their morbidity in turn. It was recently shown in the Swedish EASY trial [23], that fewer complications were observed when closing the ileostomy within 13 days of primary surgery. It would be beneficial with early closure in a day-case setting, to further decrease the morbidity associated with having an ileostomy.
Documentation of everyday life and health care following gastrostomy tube placement in children: a content analysis of medical records.
Published in Disability and Rehabilitation, 2020
Ellen Backman, Mats Granlund, Ann-Kristin Karlsson
The medical records illustrated diverse outcomes of gastrostomy tube feeding ranging from a well-functioning, alternative mode of nutrition with improvements in individual as well as social aspects, to a demanding part of daily life for some families with challenges in nursing, optimising nutrition and eating development. Daily hassles relating to the G-tube and the child’s eating were frequently described, for example, vomiting, seizures, behavioural problems and complications from the G-tube stoma. These had a negative impact on the daily routines of many families. The families of children with recurring hassles were often brought out of balance and communicated their frustration concerning healthcare contacts, preschool arrangements or in difficulties establishing sustainable feeding routines, thus negatively affecting the experience of the G-tube treatment. These results may provide one explanation for the dominance of the individual, bodily aspects seen in the medical records that show the necessity of handling acute medical issues. This study did not focus on understanding the outcome of the G-tube itself. However, the diversity in outcome highlights an important area of future research in understanding why the G-tube placement works well for some children and is associated with great struggles for others. Areas of interest include how to increase tolerance of enteral feeds, reduce reflux and vomiting and prevent skin infections around the stoma.