2. AimTo ensure that those working in adult
social care have an understanding
overview of what a stoma is, why a
person may have one and the potential
side effects
The course will also outline physical and
emotional support which may be required
by an individual who has a stoma
3. 01 Describe and follow effective
infection control and prevention
procedures
Identify and explain the different
types of stoma and the reasons
why they are fitted
Learning
Outcomes
02
05
Understand and explain the
care and support needs of the
person with a stoma and how
they can be assisted to become
independent
Understand and explain the
dietary requirements for people
with different types of stoma
03
06
Demonstrate a basic
knowledge of the digestive
system
Recognise complications and
abnormalities which may be
experienced with a stoma
04
Understand the importance
of maintaining privacy, dignity
and respect
07
Understand the importance of
maintaining accurate records
08
4. The digestive system is made up of:
The Digestive System?
The gastrointestinal (GI) tract – also called the
digestive tract – and the liver, pancreas and
gallbladder
The hollow organs that make up the GI tract are:
The mouth, oesophagus, stomach, small intestine,
large intestine (which includes the rectum) and
anus
5. The Digestive System 1
After swallowing the food is pushed into the oesophagus, then
through into the stomach
Saliva produced in the mouth, softens food ensuring that it is
right for swallowing
Once it has entered the stomach it is mixed with digestive fluids
before being released into the small intestine
How it works:
6. The Digestive System 2
Fluids from the pancreas, liver and small intestine push
the mixture forward, before the nutrients are absorbed
by the small intestine into the bloodstream
The rectum stores stool until it is pushed
from the body during a bowel movement
Muscles push the remaining undigested
food into the large intestine, where it is
mixed with absorbed water and becomes
a stool
7. Chewing – up to 1 minute
The Digestive System
Oesophagus – 30 seconds
Stomach - 2 to 4 hours
Digestion:
Intestines – 2 to 6 hours
Excretion – 10 hours to days
8. Stoma – derived from the Greek word meaning mouth or opening
What is a Stoma?
Colostomy
Ileostomy
The most common stomas are:
Urostomy
9. Colostomy
This is a surgical procedure that brings one end of
the large intestine out through the abdominal wall
During this procedure, one end of the colon is
diverted through an incision in the abdominal
wall to create a stoma
A stoma is the opening in the skin where a
pouch for collecting faeces is attached
10. Common Conditions That Can
Lead to a Colostomy
Bowel cancer
Crohn’s disease
Diverticulitis
Anal cancer
Vaginal or cervical cancer
Bowel incontinence
Injury
Hirschsprung’s disease
16. Ileostomy
The end of the remaining small intestine or ileum is then cut and
brought to the surface of the abdomen to form a stoma which is
usually situated on the right hand side of the body
This is a surgical procedure which usually involves removing
the whole of the large intestine or colon and sometimes the rectum
The ileostomy may be temporary or permanent
17. Common Diseases That Can
Lead to an Ileostomy
Ulcerative colitis –
leads to inflammation and ulceration of the lining of the large bowel, causing diarrhoea
with blood and mucus
Crohn’s disease –
an inflammatory bowel disease, which affects any part of the gastrointestinal system
which can cause pain and diarrhoea with blood and mucus
Cancerous growths affecting the colon –
affecting the colon
Familial Adenomatous Polyposis (FAP) –
an inherited condition, which affects the colon and rectum. People with FAP develop
polyps (adenomas) inside the large bowel may become cancerous
18. Types of Ileostomy
A loop ileostomy – where a loop of the small intestine
is pulled out through a hole in your abdomen, before
being opened up and stitched to the skin
There are two main ways an ileostomy can
be formed:
An end ileostomy – the colon and rectum are removed
and the end of the ileum is pulled out through a hole
in your abdomen and stitched to the skin
19. Urostomy
The stoma is created from a short piece of the small intestine
and fashioned into a tube or spout (known as an ileal conduit)
A urostomy diverts the flow of urine from the kidneys and
ureters into a stoma
The two ureters will be plumbed into this spout which will be
brought to the surface of the abdomen
Urine will continue to pass through the stoma, completely
bypassing the bladder
The bladder may or may not be removed, but the urostomy
is permanent
21. There are a number of reasons for a urostomy all of which are
connected to a defect or problem with the urinary system which
needs to be removed or bypassed
Urostomy
Babies are sometimes born with a defect of their urinary system
In adults neurological disorders leading to severe incontinence or
bladder cancer may result in urostomy surgery
22. Dietary Requirements
After surgery – best to eat as soon after surgery as
possible to keep digestive system active, food needs
chewing thoroughly
2-4 weeks – softer foods are advisable, they
are easier to digest whilst the body recovers.
Little and often.
Avoid spicy strong flavoured
foods to begin with.
Chew thoroughly
4-6 weeks – due to natural appetite reduction, protein
and energy supplements may be
required
23. Dietary Requirements
Including food that thicken output
Do not skip meals
Don’t eat and drink at the same time
Different foods will have different affects on the stoma.
To optimise stoma function:
Limiting foods that cause gas
Limiting foods that increase output
Chewing foods well and taking time with meals
Avoiding excess tea, coffee, cola and alcohol
Getting a formal assessment from a dietician
24. Some foods may increase wind and odour, these are:
Dietary Requirements
Broccoli, sprouts and cabbage
Onion, garlic, leeks, asparagus
Beans, pulses, lentils
Spicy foods
Fizzy drinks
Beer
Eggs
25. Rice, rice cakes, rice crackers
Dietary Requirements
Fresh pasta and white bread
Mashed potato
Foods that thicken output are:
Apple sauce / stewed apple
Smooth peanut butter
Ripe banana
Marshmallows and
jelly cubes
26. Dietary Requirements
Pulses, lentils
Foods that increase output are:
High fibre fruit and vegetables (sweetcorn,
leeks, onions, cabbage, mushrooms, sprouts,
peas, dried fruit, citrus fruit, rhubarb
Wholegrain cereals
Alcohol, fruit juice and caffeinated drinks
Chocolates, fatty foods
Food intolerances
28. Fish, onions, garlic and asparagus can make
the urine smelly
Urostomy Dietary Requirements
After eating beetroot, urine (and sometimes
stools) will often be pink
Urine crystals can sometimes form
in the stoma. Drinking cranberry
juice can help reduce the formation
of these crystals – if they do
form, they can be dissolved
using a cloth dampened with
white vinegar
29. Stoma Abnormalities
Normal – pink, red, warm to the touch
Abnormal – black, dusky, pale, sloughy
Colour:
Normal - intact
Abnormal – soreness, ulceration, inflammation, broken skin
Skin:
30. Stoma Abnormalities
Normal – post operative, quite swollen, may take up to 6 weeks
to reduce in size
Abnormal – sudden or unexplained swelling
Oedema:
Normal – slight smear of blood on wipe, when washing/drying stoma
Abnormal – excessive bleeding when cleaning, inside the stoma
or in the pouch
Bleeding:
37. A stoma can have a large impact on a person’s body image
and self esteem
Care and Support - Verbally
When verbally communicating with the individual, you must take into account
their emotional needs as well as the practical needs of stoma care
Ensure you are aware of the need for a private, confidential and safe
environment, as a stoma can be a very intimate and personal subject
38. Care and Support - Practically
A stoma can have a large impact on body
image and self esteem
Obtaining consent before proceeding
Agree the best place for pouch changing
e.g. the bathroom
Assist person to retain their modesty during the
procedure
Recognise any concerns about odour e.g. by using
a special deodorant spray
39. Care and Support - Independence
You can help person to achieve independence in looking
after their stoma by encouraging them to participate in stoma care
Observe their technique and give guidance accordingly
Use a step-by-step changing guide to assist the individual through the
process
Consider what factors affect the amount of assistance they require, e.g. medical
condition, age, disability, level of dexterity, confidence, etc.
40. Care and Support – Cultural and
Religious Considerations
Certain cultures may regard a stoma
as unclean
Ritual washing
Stoma siting
Cleaning with the left hand only
Dietary requirements
41. Record Keeping
The last decade has seen a shift of attitude towards the
importance of record keeping
This change has been brought about predominantly
by the promotion of individuals and relatives
to be involved in their care
History:
The access to Health Records Act 1990 –
gives individuals the right to access their manual
records
The Data Protection Act 1918 –
gives the right to access their
computer held records
Acts:
42. Record Keeping
The data subject has given their consent to the use of their information
for this purpose
Sensitive personal data may only be processed if:
Necessary to comply with legal requirements
Necessary to protect the vital interests of the data subject
i.e. life and death
Unless it is:
The information is in the public domain
Necessary for legal proceedings
In the greater interest of the public
Necessary for medical purposes
43. Record Keeping
It is important to have accurate and timely
recording and reporting in order to maintain the
continuity of stoma care, so that everyone knows
what is going on and what has been done
Any procedure being carried out and why e.g.
pouch emptying – routine pouch change –
routine pouch change because of leakage
Stoma output – record the amount (volume),
colour and consistency
Stoma condition/colour and report any changes
or problems, e.g. sudden swelling, stoma
unusually pale or dark, sore skin around the
stoma
The individual’s progress towards
independence with self-care of stoma; note
anything which they find difficult
44. Infection Control
Wash hands thoroughly
Follow manufacturer’s guidelines, care plans, risk
assessments, policy and procedure
Always wear all PPE issued
Check whether waste products can be poured
down the toilet
Check disposal instructions i.e. clinical waste,
secondary bagged
45. Stoma Bags/Pouches
Drainable bags – emptied through an
opening at the bottom of the bag
Closed bags – these need changing every
time they become full
Reusable bags – empty and reuse
Disposable bags – flushable, but not
suitable for all stomas
46. Applying the Pouch
You can apply a pouch whilst standing or sitting
Keep the skin around where you apply the
pouch wrinkle-free. If the skin around the
pouch is wrinkled, the seal may break when the
skin stretches
It may be advisable to trim any hair growing
close to the stoma site
It may be advisable when you apply a new pouch,
write the date on the adhesive tape. This will help
with when the pouch was changed last
47. Emptying or Changing the Pouch
Best emptied when 1/3 full of urine, stool or gas so it
Does not get over-full and leak or show
Changing is best before eating or drinking or first thing in the
morning when it is least active
48. 01 Describe and follow effective
infection control and prevention
procedures
Identify and explain the different
types of stoma and the reasons
why they are fitted
Learning
Outcomes
02
05
Understand and explain the
care and support needs of the
person with a stoma and how
they can be assisted to become
independent
Understand and explain the
dietary requirements for people
with different types of stoma
03
06
Demonstrate a basic
knowledge of the digestive
system
Recognise complications and
abnormalities which may be
experienced with a stoma
04
Understand the importance
of maintaining privacy, dignity
and respect
07
Understand the importance of
maintaining accurate records
08
