Stoma and Peristomal Complications and Assessment Details

Running head: STOMA AND PERISTOMAL COMPLICATIONS
STOMA AND PERISTOMAL COMPLICATIONS AND ASSESSMENT DETAILS
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1STOMA AND PERISTOMAL COMPLICATIONS
Creation of intestinal or urological stomas is an integral part of the surgical interventions for several complications such as
gastro-intestinal tract disease (Salvadalena, 2013). Numerous people undergo surgical interventions every year resulting in intestinal
or urological stoma. The modern healthcare system uses several means such as ostomy equipments or pouches, providing the patient
access to wound ostomy continence (WOC) expert nurses and advanced wound care system (Baykara et al., 2014). However, as these
means decreased the hospital stay of patients, they are unable to manage their wounds using ostomy basics, leading to high morbidity
and affecting the patient, physically, psychologically and economic prospect (Kwiatt & Kawata, 2013). These peristomal skin
complications are divided into five categories such as mechanical, infection related, noxious chemicals and irritants, skin allergies and
disease related to the skin (Jonkers et al., 2012). This assignment will be identifying five pictures related to the stoma and peristomal
infection and will discuss their etiology, pathophysiology, stoma and peristomal assessment, the way these conditions affect the
patient and the pouching system and finally recommendations to solve the problem. The assessment will be presented in a tabular
format.
Picture 1
Picture 1: Peristomal contact dermatitis
Etiology  The primary reason for this condition is exposure to
urinary or fecal drainage.
 This condition is also known as contact irritant dermatitis
and exposure to chemicals may lead to such condition
around the stoma (Haugen & Ratliff, 2013).
 It can also occur due to enzymatic drainage. Furthermore,
exposure of the stoma to adhesives, solvents and soaps as
well as leakage from the stoma pouch mat also lead to
such infection (Meisner et al., 2012).
Pathophysiology  Presence of erythema with swollen skin around the stoma,
Presence of pruritus, vesicles and papules, redness, dark
and discolored skin around the stoma
 Furthermore, the stoma was observed as oozing and a well
defined circular layer of erythema, edema and burned out
skin was observed (Grey et al., 2013).
Stomal assessment  Moist and oval shaped, red (healthy) stoma was observed.
Protrusion was around 1-2 cm from the skin surface and
located near the lower right quadrant of skin fold surface
of abdomen.
 Yellowish circular patch was observed and from the end
stoma tip a yellowish exudates was oozing which had
paste like consistency.
 It had shiny, textured and bloody appearance having oval
shaped bud, around which red swollen allergic condition
was observed

2STOMA AND PERISTOMAL COMPLICATIONS
Peristomal assessment  The peristomal area is spread around the wound in 2-3cm
radius.
 No hair was observed on the skin, however the skin
folding were present.
 The adjacent area of the peristomal skin appears red and
yellowish, yellow streaking on red erythema skin. Intact
skin integrity, moist texture, and normal turgor was
observed.
 Further, away from stoma the skin has a red rash in a
circular pattern all the way around the stoma where the
wafer would sit.
Patients condition  The patient develops irritation, itching, burning sensation,
discomfort and due to the exudates from the stoma bud,
infection spread to other body parts as well.
 This will increase the inflammation and erythema to
spread. Papules in the stomal area may lead to spread the
infection by releasing effluents (Grey et al., 2013).
 Further, the pain may also increase, as once the sensitivity
presents, it is usually permanent.
 This is because; the ostomy care products used on the skin
could potentially cause a reaction that leads to allergic
condition as well as pain sensation in the stoma area
(Martins et al., 2012).
 This might affect the patient psychologically and usage of
these costly product can affect the patient economically as
well.
Pouching system condition  The pouching system has to suffer as cleansing becomes a
challenge due to chemical and urine related infection.
 Hence, the proper pouch that can fit the area properly
should be instead of leaky pouch, which lead to spread the
exudates from one area to another leading to inflammation
and allergic condition (Grey et al., 2013).
How to deal with the problem  Correct size opening pouch system can be used,
using an ostomy belt or a convex skin barrier
instead of a flat one, using crusting method so
that dryness can be maintained
 convex barrier or flat barrier ring for stoma
management. Using warm water for cleansing
and application of stoma power for weeping can

3STOMA AND PERISTOMAL COMPLICATIONS
help in the treatment (Haugen & Ratliff, 2013).
 Usage of soaps, solvents and other chemical
products should be prohibited.
 As well as, usage of medicinal solvents should
also be prohibited as it can lead spreading if the
infection in other regions as well. This is
because swollen bruise can lead to loss of skin
(Meisner et al., 2012).
Picture 2
Picture 2: Candidiasis and folliculitis
Etiology  The primary reason is fungal infection due to overgrowth
of Candida albicans, which is the normal flora of the
mouth, gut and vagina.
 red rash, pustules and satellite lesions, may have a
collar/edge with a scaled appearance (Rippon et al., 2017)
 Traumatic hair removal due to pouch removal can be the
reason for the elevated skin surface and related infection
 Thus, inflammation leads to erythema and edema around
the stoma infection.
 Shaving the peristomal skin around the stoma prior to
application of pouch can also lead to the formation of
follicular and Candidiasis related stoma infection. Further,
occlusion of the hair follicles and in the process ripped
skin barriers can lead to stoma related infection (Huq,
Rahman & Hossain, 2014).
Pathophysiology  Leaking pouch system with red and swollen radius around
the infection
 Papules, pustules and pruritus is observed
 Satellite lesion with raised pustules was
observed due to folliculitis.
 collar/edge with a scaled appearance was also observed in
the lesion
 overgrown bud with red appearance observed (Huq,
Rahman & Hossain, 2014)
Stomal assessment  Dry and round reddish stoma was observed, having
protrusion more than 4 cm from the skin level.
 The infection is located in the lower right quadrant of the
abdomen, 4 to 5 inches elevated swollen and reddish