Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 -...
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NURSING CARES IN THE MOST
COMMON COMPLICATIONS OF
DIGESTIVE STOMA
IMMEDIATELY AFTER SURGERY.
Milagros Castro Romera Hospital Universitario de Canarias
WHAT IS A STOMA?
Surgically created opening.
Derivation of the bowel tract
to the outside of the
abdomen.
OSTOMY TYPES
Colostomy
Ascending
Transverse
Descending
Sigmoid
Ileostomy
OSTOMY COMPLICATIONS
Immediate
Oedema
Hemorrhage
Ischemia, necrosis
Infection, sepsis
Stoma retraction
Dehiscence
Evisceration
Late
Stenosis
Hernia
Prolapse
Tumor recurrence
Skin complications
Periestomal dermatitis
Ulcerations
Granulomas
Paraestomal varices
Intestinal fistulas
DEPENDING ON THE AREA
Stoma complications.
Complications of mucocutaneous junction.
Peristomal skin complications
DET SCORE Discolouration
Erosion
Tissue Overgrowth
IMMEDIATE OSTOMY COMPLICATIONS
OEDEMA
Physiological
inflammation of the
intestinal mucosa as
a result of the
manipulation of the
surgical procedure.
OEDEMA. NURSING CARES
HEMORRHAGE
Rare complication (2-3%)
During first hours after operation
Caused by a subcutaneous o submucosal vein
injury.
Late bleeding due to a small wound or
coagulation factors alteration
HEMORRHAGE. NURSING CARES
Evaluate: time of appearance, quantity, origin
and hemodynamic status.
Clear pouch (two-pieces system).
Hygiene
Local hemostasis or manual compression.
Mucosa: silver nitrate, adrenaline
Arterial surface: suture
ISCHEMIA, NECROSIS
Problems of blood supply.
Gradual color change
First 24 h
Establish the affected area.
Conservative or surgical
treatment
ISCHEMIA, NECROSIS. NURSING CARES
Colour
Extent of necrosis
Funcionality
INFECTION, SEPSIS
Asepsis
Symptoms: pain, inflammation, suppuration,
fever
From peristomal inflammation to abcess.
INFECTION, SEPSIS. NURSING CARES
Vigilance Clear pouches
Abcess Drain
Regeneration Hydrocolloid
powders
STOMA RETRACTION
Sinking of the stoma below skin level.
Causes:
Little mobilization
Increased patient weight
Septic complications Peristomal
STOMA RETRACTION. NURSING CARES
DEHISCENCE
Infection and removal of intestinal loop.
Nursing Cares:
Isolate the stoma.
Secondary intention.
Suture.
EVISCERATION
Exteriorization of an intestinal segment through
the abdominal hole.
Isolate the area with wet sterile gauzes until the
surgery.
SKIN COMPLICATIONS
PERIESTOMAL DERMATITIS
Peristomal dermatitis
Stoma
Effluent
Nutrition
General condition
Hygiene
Materials
Caregyver
TYPES OF DERMATITIS
Chemical irritant dermatitis
Mechanical dermatitis
Allergic contact dermatitis
PERIESTOMAL DERMATITIS. NURSING CARES
Characteristics
Cause
Extend and degree
Appropiate pouch
Hygiene
Protective creams, powders
hydrocolloids
Change brand of device
PREVENTION
ULCERATIONS
GRANULOMAS
Small fleshy mass appearing around the stoma
resulting from a persistent skin irritation
caused by sutures not removed in time or
rubbing the mucosa with the edge of the
device.
INTESTINAL FISTULA
Artificial communication between two cavities or between a hollow viscera organ and skin.
Classification: Internal / enteroenteric
External / eenterocutaneus
Diagnosis: Surgery
Methylene blue
Barium enema / GDS
Fistulography
CT
INTESTINAL FISTULA. NURSING CARES
Nutritional control
Pharmacotherapy
Sepsis control
Control drainage
Skin cares
Physical and mental well-being
LATE COMPLICATIONS
STENOSIS
Reduction of light reaching the stoma output
difficult stool.
Partial
Total
Nursing cares:
Diet
Digital expansion
Irrigations
HERNIA
Incisional hernia that
allows protrusion of
abdominal contents
through the abdominal
Cares
Evoid efforts
Flexible pouching systems
Stop irrigation
Surgical treatment
PROLAPSE
Bowel protrudes through the stomal opening in the skin to a greater extent than was anticipated.
Causes:
Oversized hole
Increased abdominal pressure
Excesive exertion
Infants
Obesity
PROLAPSE. NURSING CARES
Control evolution
Cold saline compresses
Avoid fhysical efforts
Manual technique
Surgery