University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

179

Pages:

2
Author:

Mariam A. A.

Psychological changes affecting a patient with a stoma and the role of a stomal therapist • Whenever possible when the need of stomas should be anticipated before the operation and informed consent should be contained. • Specialist stoma therapist should assist in planning and aftercare. • Before the operation, they should counsel the patient, who is encouraged to try out a dummy appliance and talk to other stoma patients. • The stoma therapist also identifies and marks to the most suitable and comfortable site for the stoma appliance. - This should take into account the patient’s occupation, leisure activities, clothing and ability for selfcare. - Colostomies are usually placed in the left iliac fossa and ileostomies in the right iliac fossa. Permanent vs Temporary Stomas • • Permanent stomas: - There are needed when there is no distal bowel segments remaining after resection or when for some reason the bowel is not to be rejoined. - A colostomy is required after abdominoperineal excision of low rectal or anal tumor. - An ileostomy is used after excision of the whole colon and rectum unless a pouch reconstruction is performed. Temporary stomas: - Emergency procedures: ✓ May be created as an emergency measure to relieve complete distal large bowel obstruction. - Defunctioning stomas: ✓ These may be used to protect a more distal anastomosis at a particular risk of leakage or breakdown preventing intraluminal pressure rises and diverting the faecal stream. ✓ Common examples are low rectal anastomosis. - Bowel rest: ✓ A temporary colostomy may be used to “rest” a more distal segement of the bowel or a perineum involved in an inflammatory process by diverting the faecal stream. ✓ Examples include pericolic abscess, complex anorectal fistula and major surgical perianal wounds. Psychological impacts of stomas • • • Loss of control. Body image changes: - Alteration to body image changes due to the presence of a stoma. Sexual dysfunction: • • - Challenges related to intimacy and sexual health. Social isolation: - Feelings for isolation due to stigma or embarrassment. Mood changes: - Decreased mood and emotional adjustments. Role of stomal therapist • • • • • • • • Education and Counselling: Stomal therapists educate patients, partners, or caregivers about pre- and post-operative stoma care. Positioning and Adaptation: Determine the best stoma position for each patient. Holistic Support: Address physical, emotional, and social needs. Wound Care: Assist with stoma-related wound care. Product Selection: Help patients choose appropriate supplies. Peristomal Skin Care: Prevent skin issues around the stoma. Counselling (Including Sexuality): Address psychological concerns. Advocacy and Support: Advocate for patients’ well-being.