Stoma Care Specialist Nursing: A Guide for Clinical Practice

Foreword
Preface
About the Editor/Contributors (for edited books)
Acknowledgments
Contents
Editors and Contributors
About the Editors
Contributors
1: An Introduction to Stoma Care Nursing
Introduction
Current Considerations for Stoma Care
The Role of the Stoma Care Nurse (SCN)
The Role of ASCN UK
Standards of Care
Clinical Guidelines
Competencies
Annual Conference
Conclusion
References
2: Raising the Profile of Stoma Care Nursing
Introduction
Differentiating Between Roles - What is the Specialist Role
Advanced Nurse Practitioner
Evidencing Practice
Scope of Practice
What Is Your Worth?
Audit
Improving Outcomes
Effective Communication
Identifying Specific Outcome Measures
Raising your Profile with Stakeholders
Annual Service Summary Report
Financial Considerations
Educational/PR Activities
Conclusion
References
3: Health Economics in Stoma Care
Introduction
Acute and Community Aspects of Care
Acute Setting
Community Setting
Approved Stoma Product List/Formularies
Sponsorship
The Role of the Ostomate
Conclusion
References
4: Anatomy and Physiology of the Gastrointestinal Tract and Associated Disease Processes
The Bowel Wall
The Blood Supply
Stomach
The Small Bowel/Intestine
Duodenum
The Jejunum
The Ileum
Function of Small Bowel
Absorption
Gall Bladder
Pancreas
Large Intestine
Colonic Movement
Anal Canal
Gut Microbiota
Diseases and the GI Tract
Extra- Manifestations of IBD
Familial Adenomatous Polyposis
Diverticular Disease
Colorectal Cancer Please See Chap. 5
Peptic Ulceration
Conclusion
References
5: The Management of Colorectal Cancer
Introduction
Development of Colorectal Cancer
Risk Factors
Referral Pathways
Staging of Colorectal Cancer
Treatments
Chemotherapy Agents
EGFR Inhibitors
Radiotherapy
Neoadjuvant Treatment
Rectal Cancer
Advanced Colorectal Cancer
Adjuvant Treatment
Treatment for Metastatic Disease
Surgery for Metastatic Disease
Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Immunotherapy
Palliative Chemotherapy
Colonic Stent
Palliative Short Course Radiotherapy
Anal Cancer
Conclusion
References
6: Gastrointestinal Surgery
Introduction
Approaches to Surgery
Stoma Formation
Types of Surgery
Conclusion
Appendixes
References
7: Anatomy and Physiology of the Urinary Tract and Associated Disease Processes
Renal System Development
Urological Anatomy
Kidneys
Nephrons
Adrenal Glands
Ureters
Urinary Bladder
Prostate
Urethra
Pelvic Floor
Urological Physiology
Kidney Function
Hormonal Control
Urine Production
Voiding
Urine
Disease and the Urinary System
Acute Kidney Injury
Benign Prostatic Hypertrophy
Chronic Kidney Disease
Congenital Abnormalities
Hydronephrosis
Neurogenic Bladder
Nephritic Syndrome
Nephrotic Syndrome
Overactive Bladder
Pyelonephritis
Renal Stones
Urinary Incontinence
Urinary Tract Infections and Inflammation
Urinary Tract Infection
Bladder Pain Syndrome (Interstitial Cystitis)
Radiation Cystitis
Diabetes and the Renal System
Conclusion
References
8: Urological Cancers
Cancer Pathways and Treatment Options
Prostate Cancer
Treatment Options
Bladder Cancer
Investigations
Histology
Bladder Cancer Staging and Grading: Pathology
Treatments
Non Muscle Invasive Bladder Cancer: NMIBC
BCG
Muscle Invasive Bladder Cancer: MIBC
Locally Advanced or Metastatic Bladder Cancer
Clinical Trials
Patient Follow Up
For Low Risk Disease
For Patients in the Intermediate Risk Group
For Patients in the High Risk Category
Renal (Kidney) Cancer
Investigations
Treatments
Testicular Cancer
Investigations
Treatments
Follow up
Penile Cancer
Symptoms
Investigations
Treatments
Genetics
Conclusion
References
9: Urological Surgery
Introduction
Background History
Ileal Conduit Urinary Diversion
Indication
Benign Indications
Indications with Malignancy
Ileal Conduit Formation: Surgical Procedure Description
Ureteric Stents
Turnbull Loop Ileal Conduit
Simple Cystectomy
Indications for Simple Cystectomy
Radical Cystectomy
Types of Bladder Cancer
Indications for Radical Cystectomy
Surgical Approaches in Radical Cystectomy (RC)
Open Radical Cystectomy
Laparoscopic Radical Cystectomy (LRC)
Indications for LRC
Surgical Procedure
Robotically Assisted Radical Cystectomy (RARC)
Indications for RARC
Pre Operative Preparation and Care Considerations
Post Operative Care Considerations and Common Complications
Altered Bowel Habit
Post Operative Weight Loss
Fluid Loss per Urethral/Vagina Post Cystectomy
Anticoagulant Therapy
Urinary Tract Infections
Common Presenting Symptoms of a UTI
Common Longer Term Conditions Leading to UTI
Other Immediate Post Operative Complications Post RARC and LRC
Visual and Hearing Disturbance
Other Types of Urinary Diversion
Vesicostomy
Indication
Surgical Procedure
Complications and Nursing Considerations
Cutaneous Ureterostomy
Indication
Complications and Nursing Considerations
Appliance Selection
Conclusion
References
10: Stoma Management
Stomas
Preoperative Assessment
Preoperative Information
Preoperative Stoma Care Training
Postoperative Care
Practical Stoma and Discharge Planning
Skin Care
Appliances
Diet
Activities
Long-Term Care
Colostomy
Colostomy Output and Function
Colostomy Appliances
Dietary Considerations for a Person with a Colostomy
Challenges Specific to Managing a Colostomy
Ileostomy
Ileostomy Appliances
Ileostomy Output
Ileostomy Appliance Emptying
Changing an Ileostomy Appliance
Dietary Considerations for a Person with an Ileostomy
Ileostomy Related Issues
Urostomy
Urostomy Appliance
Night/Drainage Bags
Leg Bags
Appliance Adaptors
Appliance Changing Interval
Stoma Output
Challenges Specific to Managing a Urostomy
Other Specific Issues
Bleeding
Medication Effects
Cultural Issues
Conclusion
Appendix 1. ASCN UK (2021) Convexity Guideline
Appendix 2. ASCN UK (2022) Cultural and Religious implications relating to stoma care.
References
11: Patient Assessment and Stoma Siting
Introduction
History
Holistic Assessment
Pre-Operative Assessment
Considerations of Stoma Siting
Stoma Siting Practice
Documentation
Conclusion
References
12: Managing Difficult Stomas
Introduction
Necrosis
Partial/Full Retraction
Stenosis
Mucocutaneous Separation (MCS)
Signs and Symptoms
Granulomas
Stomal Prolapse
Signs and Symptoms
Treatment
Parastomal Hernia
Causes
Frequency of Occurrence
Complications
Management
High and Low Stoma Output
High Output Stomas (HOS)
Definition
Acute HOS
Sub-Acute HOS
Chronic HOS
Management of HOS
Stoma Care Equipment: Management
Low Output Stomas
Management of Urostomy
Management of Ileostomy
Management of Colostomy
Caput Medusa (Parastomal Varices) (See Photo 12.4)
Trauma
Treatment
Conclusion
Appendix 1 ASCN UK (2019) Granuloma Management, ASCN UK Stoma Clinical Guidelines www.ascnuk.com
Appendix 2 ASCNUK (2019) Hernia Management, ASCN UK Stoma Clinical Guidelines www.ascnuk.com
Appendix 3 ASCNUK (2019) Hernia Prevention, ASCN UK Stoma Clinical Guidelines www.ascnuk.com
References
13: Peristomal Skin Issues and Their Management
Introduction
Skin Health in Stoma Patients
Functions of Skin
Anatomy
Skin Issues/Complications
Assessment
Categories and Descriptions
Group 1.Rash: Folliculitis
Symptoms
Causes
Treatment
Prevention
Group 1. Infection: (a) Impetigo
Description
Symptoms
Treatment
Group 1. Infection: (b) Cellulitis
Description
Symptoms
Treatment
Group 1.Infection: (c) Candida
Description
Symptoms
Treatment
Group 1. Pemphigoid Bullous
Description
Symptoms
Treatment
Group 1. Psoriasis
Description
Cause
Symptoms
Treatment
Further Information
Group 1. Peristomal Medical Adhesive Related Skin Injury (PMARSI)
Description
Symptoms
Treatment
Group 1. Dermatitis: Contact Irritant and Contact Allergy
Description
Cause
Symptoms
Treatment
Group 2. Ulceration: Pyoderma Gangrenosum (PG)
Description
Cause
Symptoms
Treatment
Group 2. Gangrene
Description
Symptoms
Cause
Treatment
Group 2. Nicorandil Ulceration
Description
Cause
Symptoms
Treatment
Group 3 Raised Lesions: Granulomas
Definition
Cause
Symptoms
Treatment
Group 3 Chronic Papillomatous Dermatitis
Definition
Symptoms
Causes
Treatment
Group 3 Malignancy (Metastatic Adenocarcinoma)
Description
Cause
Symptoms
Treatment
Group 3 Cutaneous Crohn’s Disease (CD)
Description/Cause
Symptoms
Treatment
Documentation
Quality of Life and Implications for Patient Care
Conclusion
References
14: The Management of Enterocutaneous Fistula
Introduction
Background
Holistic Patient Assessment
Resuscitation
Imaging
Nutritional Support
Conservative or Surgical Treatment
Skin Integrity
Conclusion
Appendix 1. Fistula_management
References
15: Paediatric Stoma Care
Introduction
Conditions that May Require Formation of a Stoma in Paediatrics
Anorectal Malformations
Necrotising Enterocolitis
Malrotation with Midgut Volvulus
Intussusception
Hirschsprung’s Disease
Chronic Intestinal Pseudo-Obstruction
Crohn’s Disease and Ulcerative Colitis
Paediatric Considerations
The Preterm and Neonate
Babies and Children
Points to Remember
Teenagers/Young Adult
Use of Social Media—Positives and Negatives
The Law
Nutrition
Stoma Products Used in Paediatrics
Conclusion
References
16: Body Image and Sexuality
Introduction
Functional Problems Following Stoma Surgery
What is Body Image?
Body Image with a Stoma
Assessing Perceived Changes in Body Image
Addressing Concerns About a Change in Body Image
Difficulties Exploring Sexuality After Stoma Surgery
Lesbian Gay Bisexual Transgender Intersex Queer (LGBTIQ)
Conclusion
References
17: Supporting Patients Beyond the Clinic
Introduction
Locating Charities in the Landscape of Care
A Charity Offering: A Case Study of Colostomy UK
Support
24-Hour Stoma Helpline
Private Facebook Support Group
Tidings Magazine
Support Literature
Website and Live Chat
Campaigns and Projects: Active Ostomates
Conclusion
Reflective Questions
References
18: Living with Long Term Conditions
Introduction
What is a Long Term Health Condition?
The Impact of Health Inequalities
Stoma Care
Reducing the Health Impact of Stoma Formation in the Elective Patient
The Health Impact of Stoma Formation in the Emergency Patient
Considerations of Having a Stoma as a Long-Term Health Condition
Annual Clinical Review (ACR) and Appliance User Reviews (AUR)
Mental Wellbeing and Quality Life
The Stoma Patient with a Diagnosis of Dementia
Conclusion
Appendix 1 Quality of Life Questionnaire
Appendix 2 ASCN UK Dementia guideline 2022
References