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Sedigheh Aghaei BSN –ETN WOCN

Sedigheh Aghaei BSN –ETN WOCN. Stoma Immediate complications. Infection Bleeding Stomal edema Excessive secretion Necrotic stoma tissues Mucocutaneous separation. Necrosis. Cause: Deficient blood supply Management: Observation Surgical revision. Late complication of stoma.

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Sedigheh Aghaei BSN –ETN WOCN

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  1. SedighehAghaei BSN –ETN WOCN

  2. Stoma Immediate complications • Infection • Bleeding • Stomal edema • Excessive secretion • Necrotic stoma tissues • Mucocutaneous separation

  3. Necrosis • Cause: • Deficient blood supply • Management: • Observation • Surgical revision

  4. Late complication of stoma • Stomal ulcer • Stomal Retraction • Stoma Prolepses • StomalStenosis • Stomal hernia

  5. Stoma Complications Retraction Stenosis Prolapse Necrosis Herniation Phosphatic Deposits

  6. Priostomal Hernia • Causes: • Weakened abdominal muscles • Inadequate surgical suturing • Management: • proper stoma siting • avoid lifting heavy objects • Use flexible appliances • surgery if blood supply impaired

  7. Stenosis Cause: • Scar tissue formation • Stoma retraction Management: • Prevent excoriation/scar formation • Dilatation • Surgical reconstruction

  8. Prolapse Causes: • Weakened abdominal muscles • Oversized incision opening • Heavy lifting • Ascites • Disruption of internal attachments securing the bowel

  9. Management of Prolapse: • Observe for color changes in stoma • Reduce swelling • Manual reduction before base plate • Measure base of stoma • Surgical correction

  10. Stomal Retraction May occur immediately post-Op • Necrosis of stoma tissue with scar • Tension on the bowel the • Weight gain cause fatty tissues to bulge outwards around the stoma • complication of chemotherapy

  11. Pressure ulcers Tight base plate most common cause

  12. Pressure ulcers Causes : • Tight base plate most common cause • Rad • Cut base plate too fit Management: • Remove cause • Use barrier wipe • Get a good seal on the appliance & protect the skin • Correct leakage • Cut base plate fit

  13. Priostomal Skin Problems

  14. Priostomal Skin Problems • Allergic skin reactions • Contact Dermatitis • Folliculitis • Maceration • Bacterial Infection • Fungal Infection Candidacies

  15. Priostomal Skin Problems • Allergic skin reactions • Causes: • Skin cleanser • Skin protector • Appliance & Dressings. • Tape • Radiotherapy • Poor hygiene

  16. Excoriated skin around stoma Causes : • Long term ileostomate • Stoma output 600 ml daily of faeces • Sore skin for 2 weeks • Poor stoma sitting

  17. Skin excoriation Causes: • wafer opening too large • improperly fitted skin barrier or poor adhesive • Priostomal skin folds /creases • leakage underneath wafer not attended to • Priostomal skin not properly cleaned Management: • remove cause • correct leakage • Stomahesive powder • Skin barrier

  18. Folliculitis Cause: • Removal of hair from follicles by aggressive adhesives Management: • Shave Priostomal hair • Use barrier wipe • Corticosteroid spray

  19. Alkaline Encrustation (urine crystal formation) Cause: • prolonged contact with alkaline urine • wafer used for too long • opening too large Management: • Add 1-2 drops of vinegar in cleansing fluid for cleansing • Increase fluid intake Vit C

  20. Thank You

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