Case Study 34.3
Due to poor response to medication, Julie and the medical team have decided she requires a planned colectomy with ileostomy (subtotal). She has an appointment with the stoma nurse to discuss having a stoma and where to site the stoma.
1. What information would you want to know if you were Julie?
Read: Brown, F. (2017). ‘Psychosocial health following stoma formation: a literature review’, Gastrointestinal Nursing, 15 (3). https://doi.org/10.12968/gasn.2017.15.3.43
2. What areas of psychological support and physical care will the stoma nurse provide Julie with?
The nurse can discuss areas such as body image, intimate relationships, hobbies and how to care for the stoma. Education pre-op is extremely important and can aid the patients recovery post operatively. It can be advantageous for the patient to meet another patient who is coping with living with a stoma. The patient that they meet should ideally be the same sex, similar age and have a similar lifestyle to enable the preoperative patient to identify and relate with them.
Read: Cronin, E. (2014). ‘Stoma siting: why and how to mark the abdomen in preparation for surgery’, Gastrointestinal Nursing, 12 (3). https://doi.org/10.12968/gasn.2014.12.3.12
3. What factors will the stoma nurse consider with Julie when siting her stoma?
To ensure that the stoma is not positioned in an awkward place which may cause the patient problems post operatively.
Factors to consider
- Skin folds on abdomen, if placed on one of these the stoma bag would not adhere flatly to the skin. Therefore the bowel contents could leak around the bag causing skin damage. Plus embarrassment for the patient
- Clothing the patient wears and the waist line of their clothes
- Scars and skin condition
- Bony prominences and umbilicus.
- Occupation and physical activities at work or hobbies
- Culture and religious beliefs
- Manual dexterity and visibility