nursing cares in the most common complications of ...sobest.org.br/arquivos/cbeaulas/dia2/10h00 -...
TRANSCRIPT
![Page 1: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/1.jpg)
NURSING CARES IN THE MOST
COMMON COMPLICATIONS OF
DIGESTIVE STOMA
IMMEDIATELY AFTER SURGERY.
Milagros Castro Romera Hospital Universitario de Canarias
![Page 2: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/2.jpg)
![Page 3: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/3.jpg)
WHAT IS A STOMA?
Surgically created opening.
Derivation of the bowel tract
to the outside of the
abdomen.
![Page 4: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/4.jpg)
OSTOMY TYPES
Colostomy
Ascending
Transverse
Descending
Sigmoid
Ileostomy
![Page 5: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/5.jpg)
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
![Page 6: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/6.jpg)
DEPENDING ON THE AREA
Stoma complications.
Complications of mucocutaneous junction.
Peristomal skin complications
![Page 7: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/7.jpg)
DET SCORE Discolouration
Erosion
Tissue Overgrowth
![Page 8: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/8.jpg)
![Page 9: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/9.jpg)
IMMEDIATE OSTOMY COMPLICATIONS
![Page 10: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/10.jpg)
OEDEMA
Physiological
inflammation of the
intestinal mucosa as
a result of the
manipulation of the
surgical procedure.
![Page 11: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/11.jpg)
OEDEMA. NURSING CARES
![Page 12: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/12.jpg)
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
![Page 13: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/13.jpg)
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
![Page 14: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/14.jpg)
ISCHEMIA, NECROSIS
Problems of blood supply.
Gradual color change
First 24 h
Establish the affected area.
Conservative or surgical
treatment
![Page 15: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/15.jpg)
ISCHEMIA, NECROSIS. NURSING CARES
Colour
Extent of necrosis
Funcionality
![Page 16: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/16.jpg)
INFECTION, SEPSIS
Asepsis
Symptoms: pain, inflammation, suppuration,
fever
From peristomal inflammation to abcess.
![Page 17: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/17.jpg)
INFECTION, SEPSIS. NURSING CARES
Vigilance Clear pouches
Abcess Drain
Regeneration Hydrocolloid
powders
![Page 18: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/18.jpg)
STOMA RETRACTION
Sinking of the stoma below skin level.
Causes:
Little mobilization
Increased patient weight
Septic complications Peristomal
![Page 19: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/19.jpg)
STOMA RETRACTION. NURSING CARES
![Page 20: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/20.jpg)
DEHISCENCE
Infection and removal of intestinal loop.
Nursing Cares:
Isolate the stoma.
Secondary intention.
Suture.
![Page 21: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/21.jpg)
EVISCERATION
Exteriorization of an intestinal segment through
the abdominal hole.
Isolate the area with wet sterile gauzes until the
surgery.
![Page 22: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/22.jpg)
SKIN COMPLICATIONS
![Page 23: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/23.jpg)
PERIESTOMAL DERMATITIS
Peristomal dermatitis
Stoma
Effluent
Nutrition
General condition
Hygiene
Materials
Caregyver
![Page 24: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/24.jpg)
TYPES OF DERMATITIS
Chemical irritant dermatitis
Mechanical dermatitis
Allergic contact dermatitis
![Page 25: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/25.jpg)
PERIESTOMAL DERMATITIS. NURSING CARES
Characteristics
Cause
Extend and degree
Appropiate pouch
Hygiene
Protective creams, powders
hydrocolloids
Change brand of device
PREVENTION
![Page 26: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/26.jpg)
ULCERATIONS
![Page 27: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/27.jpg)
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.
![Page 28: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/28.jpg)
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
![Page 29: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/29.jpg)
INTESTINAL FISTULA. NURSING CARES
Nutritional control
Pharmacotherapy
Sepsis control
Control drainage
Skin cares
Physical and mental well-being
![Page 30: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/30.jpg)
LATE COMPLICATIONS
![Page 31: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/31.jpg)
STENOSIS
Reduction of light reaching the stoma output
difficult stool.
Partial
Total
Nursing cares:
Diet
Digital expansion
Irrigations
![Page 32: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/32.jpg)
HERNIA
Incisional hernia that
allows protrusion of
abdominal contents
through the abdominal
Cares
Evoid efforts
Flexible pouching systems
Stop irrigation
Surgical treatment
![Page 33: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/33.jpg)
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
![Page 34: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/34.jpg)
PROLAPSE. NURSING CARES
Control evolution
Cold saline compresses
Avoid fhysical efforts
Manual technique
Surgery
![Page 35: Nursing cares in the most common complications of ...sobest.org.br/arquivos/CBEAULAS/dia2/10H00 - MILAGROS ROMERA.… · COMMON COMPLICATIONS OF DIGESTIVE STOMA IMMEDIATELY AFTER](https://reader033.vdocuments.mx/reader033/viewer/2022042208/5eab8756c0a3284ad66b8325/html5/thumbnails/35.jpg)