Assessment And Management Of Stoma And Peristomal Complications

· This condition is also known as contact irritant dermatitis and exposure to chemicals may lead to such condition around the stoma (Haugen & Ratliff, 2013).

· It can also occur due to enzymatic drainage. Furthermore, exposure of the stoma to adhesives, solvents and soaps as well as leakage from the stoma pouch mat also lead to such infection (Meisner et al., 2012).

· Furthermore, the stoma was observed as oozing and a well defined circular layer of erythema, edema and burned out skin was observed (Grey et al., 2013)Assessment And Management Of Stoma And Peristomal Complications.

· Yellowish circular patch was observed and from the end stoma tip a yellowish exudates was oozing which had paste like consistency.

· It had shiny, textured and bloody appearance having oval shaped bud, around which red swollen allergic condition was observed

· No hair was observed on the skin, however the skin folding were present.

· The adjacent area of the peristomal skin appears red and yellowish, yellow streaking on red erythema skin. Intact skin integrity, moist texture, and normal turgor was observed.

· Further, away from stoma the skin has a red rash in a circular pattern all the way around the stoma where the wafer would sit.

· This will increase the inflammation and erythema to spread. Papules in the stomal area may lead to spread the infection by releasing effluents (Grey et al., 2013).

· Further, the pain may also increase, as once the sensitivity presents, it is usually permanent.

· This is because; the ostomy care products used on the skin could potentially cause a reaction that leads to allergic condition as well as pain sensation in the stoma area (Martins et al., 2012)Assessment And Management Of Stoma And Peristomal Complications.

· This might affect the patient psychologically and usage of these costly product can affect the patient economically as well.

· Hence, the proper pouch that can fit the area properly should be instead of leaky pouch, which lead to spread the exudates from one area to another leading to inflammation and allergic condition (Grey et al., 2013).

· convex barrier or flat barrier ring for stoma management. Using warm water for cleansing and application of stoma power for weeping can help in the treatment (Haugen & Ratliff, 2013).

· Usage of soaps, solvents and other chemical products should be prohibited.

· As well as, usage of medicinal solvents should also be prohibited as it can lead spreading if the infection in other regions as well. This is because swollen bruise can lead to loss of skin (Meisner et al., 2012).

· red rash, pustules and satellite lesions, may have a collar/edge with a scaled appearance (Rippon et al., 2017)

· Traumatic hair removal due to pouch removal can be the reason for the elevated skin surface and related infection

· Thus, inflammation leads to erythema and edema around the stoma infection.

· Shaving the peristomal skin around the stoma prior to application of pouch can also lead to the formation of follicular and Candidiasis related stoma infection. Further, occlusion of the hair follicles and in the process ripped skin barriers can lead to stoma related infection (Huq, Rahman & Hossain, 2014)Assessment And Management Of Stoma And Peristomal Complications.

· Papules, pustules and pruritus is observed

· Satellite lesion with raised pustules was observed due to folliculitis.

· collar/edge with a scaled appearance was also observed in the lesion

· overgrown bud with red appearance observed (Huq, Rahman & Hossain, 2014)

· The infection is located in the lower right quadrant of the abdomen, 4 to 5 inches elevated swollen and reddish allergic area was present around the stoma.

· Loop stoma was observed having dark red color, the appearance of the bud was shiny, dry and bloody having a circular appearance

· Scars and crusty skin integrity, with firm turgor was assessed

· Round or rotund abdomen.  Further, away from stoma the skin has a red rash in a circular pattern all the way around the stoma where the wafer would sit.

Financial and psychological impact might also impact the patient condition

Physically as well, the position of scar was such that the patient would not be able to move freely.

· Therefore, lift of, and secondary accessory might be seen in this scenario.

· The pouch becomes loose, leading to spread the infection from the stoma to another portions of the body (Beitz & Colwell, 2016)Assessment And Management Of Stoma And Peristomal Complications.

· If the patient has history of fungal infection, then prophylactic treatment should be used, the caretaker and patient should be taught the skills to protect stoma infection in condition of Candidiasis and folliculitis (Rippon et al., 2017).

· The pouch should be changed in short term duration and in that process, usage3 of antifungal treatment powder should be applied in the inflammated area.  These antifungal powders (Nystatin and Mycostatin) should be used to dust the area, massage on the reddish skin around the stoma, let sit for several minutes. Further, excess powder after massage of the skin should be removed prior to application of pouch (Lyon, 2016).

· Further, not proper cleansing of the peristomal skin may also lead to allergic conditions (Kaur et al., 2012).

· Usage of film barriers or additional tape may also involve in the cause of such infectious condition.

· Furthermore, an appliance having a bad fitting, letting moisture or vapor infect the area may also lead to such allergic condition.

· Whereas, frequently changing apparatus, ripping off the appliances, irregular borders and abrasive cleansing of the area also leads to allergic condition in case of stoma related infections (Watson et al., 2013).

· Furthermore, the patient feels itching, burning or stinging around the infection site (González-Rodríguez et al., 2013)Assessment And Management Of Stoma And Peristomal Complications.

· Partial or full thick allergic reaction may be seen near the stomal area. Regular or irregular swollen border around the stoma bud is the characteristic of allergic contact dermatitis.

· This infection is itchy and painful and might lead to spread due to exudates release (Kaur et al., 2012)

· flush or low profile stoma

· end stoma, intact muco-cutaneous junction

· Lumen was observed in the4 center of stoma

· Likely an ileostomy as it is on the right lower quadrant

· However, the skin color is healthy.

· The skin integrity is intact.

· No hair was observed on the body.

· The skin texture is crusty, normal skin turgor (palpation test)

· Away from stoma, the skin has a red rash in a circular pattern all the way around the stoma where the wafer would sit.

· Lower right hand aspect of the skin shows mechanical stripping and denuded skin.

· It can affect the activities of daily life of the patient

· Further discomfort can affect the mental state and to treat that financial strength would be required. Hence, all the aspect might suffer due to this wound.

· The place of stoma was such that it may affect the integrity oif pouching as lift up might occur, and pouch management was crucial.

· Specific secondary accessories might also be required to keep the pouch on the place.

· The fragranced stoma bag deodorizer should be checked, the stoma appliances such as soaps, wipes adhesive removers should be checked for allergic dermatitis.

· The caretaker of the patient should use non-oily steroid cream and powder (Gardiner, 2013).

· To protect the stoma, an interface such as a Coloplast barrier sheet can be used if any proper pouching system is not available that can properly fit in the stomal region (González-Rodríguez et al., 2013).

· The stoma developed contact dermatitis because of the presence of infected substances around the patient

· The ulcer may spread due to open surface and microbial infection as well as due to the release of exudates from the stoma (Wu & Shen, 2013)Assessment And Management Of Stoma And Peristomal Complications.

· Further, the allergic condition may be due to irritants or pouch related allergens used in the process.

· The ragged edges of the swollen skin around the stoma are whitish or yellowish in color and the skin is hard and broken textured which may lead to blackish blemish

· The cavity was 2-3cm deep, located in the smoother section of the belly. Possible the left lower section of the body.

· The periphery of the cavity was swollen and reddish allergic condition was observed.

· Red mucus was observed, which determines healthy stoma. Further, shiny, smooth and textured cavity was observed

· Lumen was present in the center of the stoma and it was in developing stage with intact muco-cutaneous junction.

· The peripheral skin was normal in color and therefore denoted healthy peri-stoma however had broken structure with whitish skin rashes.

· Redness was observed due to the allergy spread by the released exudates from the stomal cavity, which made the skin around the cavity inflammated and leading to symptoms of erythema and edema around the stoma where the wafer would sit.

· Further, the patient suffers from high risk of microbial infection that can occur from the normal microbial flora of skin in that area

· However, less financial and much more psychological trauma can be faced by the patient

· However due to the smoth surface, it will not dislocate of lift up.

· With the increasing size of stoma, the pouch wear time and need of addition of secondary accessories can be increased,

· Therefore, special cavity convex pouches should be used for the protection of the stoma

· Further Pain management and Time management is also beneficial in the faster healing of the wounds.

· Cleansing and hygiene should be maintained properly as this stomal condition may lead to severe condition.

· Hence, the care taker and the patient as well should take care of cleansing using medicinal solvents and warm water should be done so that further infection can be prevented (Fahmy et al., 2012).

· It is often associated with autoimmune diseases such as ulcerative colitis, Crohn’s disease and rheumatoid arthritis (Ahmad et al., 2017).

· There is also a possibility that due to not frequent changes of the pouch of this stomal region, infection spreads through the exudates.

· People with blood disorders (hematologic malignancies) are at increased risk of pyoderma gangrenosum

· Further, the circular periphery had reddish swollen skin represented erythema and edema (Randall et al., 2012)Assessment And Management Of Stoma And Peristomal Complications.

· Reddish moist mucosa was observed in the center.

· The stoma was present on a smooth surface. Healthy reddish stoma, with shiny and textured layer was observed. Further, around the stoma small holes having yellow patches were observed.

· Possibly, it is the right upper quadrant of the body.

· However, the closer skin had several perforations in it.

· Further, away from stoma the skin has a red rash and it was spread unevenly.

· It was a plane surface for the wafer to sit on.

· Lower right hand aspect of the skin shows mechanical stripping and denuded skin

Psychologically having around on upper left quadrant can impact the patient as it would stay always in their mind and they will not be able to move freely. However, financially it is not that costly to avail treatment of this system.

· Further, due to irregular shape of the stoma and protruded and barrel shaped non-cellular lumen of the stoma, it is difficult to properly cover this stoma with pouch, hence, the brand will be changed and special bandage or custom pouches made for the specific stoma will be used to protect this lesion (Randall et al., 2012).

· This will affect the general bandage time, as it will frequently lift off the place. Hence, to make it stay on the place secondary accessories will be used.

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· Od puch changes will be used for wound management

· Properly fitting appliances will also be used as secondary accessories to protect the infection from moisture (Grey et al., 2013)Assessment And Management Of Stoma And Peristomal Complications.

· Using convex shaped pouch can be helpful in this condition, as the convex shaped pouch has and outward curve, that puts enough pressure around the stomal area and this pressure will help the stoma to protrude into the pouch.

· Topical steroidal agent and systemic steroidal therapy will be used for this purpose.