Nursing Roles and Interventions in Ostomy and Stoma Management

This report provides a comprehensive overview of ostomy and stoma care within the nursing context. It begins with an introduction to ostomies, defining them as artificial openings created during surgery for the exit of bodily waste, and identifies various physiological problems that may necessitate ostomy procedures, such as inflammatory bowel disease, birth defects, and cancer. The report then details the crucial role of the stoma nurse, encompassing patient support, coordination of treatment, practical advice, and emotional navigation. It thoroughly examines the care provided by nurses during the pre-operative, peri-operative, and post-operative stages, including assessment, information provision, and intervention. Furthermore, the report highlights interventions like wound care and pain management, along with essential educational needs for stoma care nurses. It also outlines the importance of a multidisciplinary team for ostomy care and emphasizes safety considerations such as appliance application and post-operative stent use. Finally, the report explores patient assessment strategies, including appliance inspection and output evaluation, concluding with the significance of nursing interventions in effective patient management.

Ostomy and stoma
care for patients in
nursing.

Introduction
 An Ostomy is considered as an artificial opening in specified
organs of the body which is usually created during an operation
(Krouse et al., 2016).
 It is usually referred to the change in the way of exit of urination or
passage of stool from the body as a result of surgical procedure.
 Ostomy surgery often includes the procedures for the exit of body
wastes which surgically creates stoma which has been on the
abdomen through a prosthetic known as stoma bag.

Psysiological problems leading to
need of ostomy
Inflammatory bowel disease
Birth defects
Incontinence Pelvic
trauma
Diverticultit
is
Cancer

Role of the Stoma nurse in ostomy
care
 Provision of patient support
 Co-ordination of treatment processes like liaising with surgical team
 Discussion regarding interventions with multi disciplinary team
 Practical advice for management of stoma
 Marking of the stoma for proper treatment through surgery
 Emotional navigation through changes in the body after surgery (Tao et
al., 2014).

Care provided by the nurse during
pre-operative stage
Conducting a
preoperative
assessment which
would be a critical
care of dimension
in the preoperative
environment.
Improvement of
the quality of care
and restoring the
patient to the
desired level
inclusive of proper
functioning (Malley
et al., 2015).
Nurse should
provide necessary
information and
clarify expectations
which are related
to the preoperative
course for
preparation of the
patient’s mentally.

Care provided by the nurse during
peri-operative stage
Perioperative nurse Surgeon
Assistant(PSNA)- surgery. Provides
competent care to the team during
pre surgery, intra surgery,
extended surgery as well as post
Instrument nurse- would help
with all the supplies and would aim
at anticipation of the needs of the
surgical team.
Scrub nurse- Often assists an
instrument nurse helps in ensuring
the cleanliness of the theatre and
sets it up for use.
Anesthetic nurse- Provides
support to the patient and helps in
the provision of anesthetic before
and during the procedure.
NURSES DURING
OPERATION

Care provided by the nurse during
post-operative stage
Provision of a safe and private
environment
Providing psychological support
Recording the progress in the patients'
healthcare methods following
intervention

Overall role of the stoma care nurse
during pre, peri, post operative
periods.
Local referral
policies for
requiring a
stoma
Obtains
information
regarding
medical history
of the patient
Discusses an
plan of care for
the patient
Ascertains their
physical and
emotional care along
with their social
circumstances and
beliefs
Is aware of the
policies regarding
confidentiality of
the patients

Interventions
 Wound care – Interventions for filling the dead space ,
absorbing the wound exudates , maintaining a clean wound bed
and changing of pouching systems
 Sepsis Administration of intravenous antibiotics within 1hour of
presentation. Frequent checking of the blood cultures, serum
lactate isotonic fluid bolus and antibiotics.
 Pain management- pain medication by consulting with the
general practitioner (Tam et al., 2014).

Educations needs of stoma care
nurse
 Awareness for effective treatment of Ostomy
 Patient centered care approach
 Increased information through demonstration of care, instructional
videos
 Adequate staff education and knowledge about maintenance of an up
to date Ostomy care (Worth, Shcutlle & Stommel, 2014).

Multidisciplinary team for Ostomy
care
ET nurse psychologis
t
surgeon Stoma care
nurse

Safety considerations for ostomy
1.
2.
3.
Applying pouch for stopping the flow of body fluids
Use of stent postoperatively for prevention of stenosis of
ureters
Waiting for one or two hours for changing the urostomy
appliances (Tilly, Lipson & Ramos, 2016).