GUIDE QUESTIONS AND ANSWERS SURE A+
✔✔Why might a patient with a urinary diversion be at risk for receiving antibiotics
inappropriately? - ✔✔Patients with incontinent bowel diversion have chronic bacteriuria
and will have positive urine cultures = multiple rounds of antibiotic treatment and multi
drug resistant organisms. Antibiotic treatment should only be started with patients who
have other clinical signs of active infection.
✔✔ideal stoma characteristics - ✔✔*height/protrusion
*round
*red
*moist
*painless
*may bleed easily
*lumen at the center of stoma
✔✔stomal complication etiology - ✔✔vascular issues, infection, iatrogenic, long term
changes
✔✔peristomal moisture associated skin damage - ✔✔inflammation and erosion of the
skin adjacent to the stoma due to exposure to effluent of other moisture
✔✔Irritant contact dermatitis - ✔✔a type of PMASD caused by exposure to effluent,
lotions, creams, and skin care products
✔✔maceration - ✔✔a type of PMASD caused by pouch leakage which allows the
peristomal skin to become over moist and water-logged
✔✔pseudoverrucous lesions - ✔✔a type of PMASD caused by prolonged and/or
chronic exposure of peristomal skin to effluent
causes thick, raised, bumpy, irregular lesions around the stoma
, ✔✔peristomal varices - ✔✔caused by portal hypertension that leads to enlarged venous
channels
may be visible as dilated veins in the submucosal area, blueish discoloration of the
peristomal skin, or raspberry-like appearing stoma
✔✔peristomal granuloma - ✔✔occur as an immunologic response to foreign material or
friction/rubbing
red, soft and firm, papules located at the stoma and peristomal junction
✔✔mucosal transplantation - ✔✔occurs when the bowel is inadvertently sutured to the
epidermis instead of the dermis
several bright, red, moist papules, often friable
✔✔early stoma complications - ✔✔(those that occur within 30 days of surgery)
*mucocutaneous separation
*stomal necrosis
*stomal retraction
✔✔late stoma complications - ✔✔(those that occur greater than 30 days after surgery)
*stomal stenosis
*stomal prolapse
*stomal trauma
*parastomal hernia
✔✔mucocutaneous separtaion - ✔✔detachment of the stomal tissue from surrounding
peristomal tissue
managed with wound care, larger separations may need antimicrobial dressings or
systemic antibiotics
✔✔stomal necrosis - ✔✔death or stomal tissue resulting from tissue ischemia
usually a watch and wait scenario, superficial necrosis will eventually fall off and reveal
a healthy stoma, if necrosis is deep urgent surgery is indicated
✔✔stomal retraction - ✔✔disappearance of stomal tissue in line with or below the line of
the skin
convex pouching system of ostomy belt can be used to augment stomal height to
improve pouching success