Journal of Community Nursing - page 74

74 JCN
2013,Vol 27, No 4
STOMA CARE
region to skin stripping, including
the patient’s age (Konya et al, 2010)
and disease-specific conditions, such
as epidermolysis bullosa, infantile
eczema, atopic dermatitis and
dermatological changes associated
with diabetes (Hollinworth, 2009).
Patients can also experience
allergic reactions to a stoma
appliance (although this is rare)
(Lawson, 2003), and there can also
be granulation on the edge of the
stoma and the adjoining skin, an
area termed the mucocutaneous
junction (Burch, 2010).
This granulation is mainly thought
to be caused by faeces coming into
contact with the skin (Lawson,
2003), or because of a poorly fitted
appliance, which irritates the area
(Smith et al, 2002). All of these factors
can weaken the skin, making it sore
(Burch, 2010) and more vulnerable to
further damage from the removal and
application of stoma appliances.
Adhesives work by knitting
into the skin’s top layer and when
adhesive tape or substances
are removed from the skin they
inevitably strip a certain amount
of the stratum corneum (Cutting,
2008). While it is essential that the
stoma pouch is properly sealed
around the stoma, repeated removal
and application during pouch
changes can weaken and begin to
strip the skin. Similarly, if the flange
is pulled out without due care,
the top layers of the skin can be
removed with it.
Repeated stripping of the skin
damages the peristomal area and
delays healing. It also interferes with
the skin’s barrier function, which
increases transepidermal water loss
(TEWL), a recognised and validated
method of measuring damage to the
skin’s barrier properties (Elkeeb et
al, 2010). Skin stripping causes pain
and can also widen the wound edges,
delay healing, cause an inflammatory
response and increase infection risk
(Cooper, 2010).
Excess moisture around the stoma
can also impact on the effectiveness
of the replacement pouch’s adhesion
(Cutting, 2006).
Hydrocolloid adhesive is now
considered the optimum material for
adherence of the stomal pouch and
its use has certainly improved on
previous substances, particularly with
regards to moisture absorption (Berry
et al, 2007).
However, the necessary frequency
of stoma changes and the continual
removal of the dressing around the
stoma will inevitably take their toll
on the skin — and because changes
are usually made daily, this damage
is continually compounded (Berry et
al, 2007).
Leakage can also affect the
confidence and quality of life of the
patient, as what is often a hidden
function is now at risk of being
exposed due to odour (Swan, 2010).
QUALITY OF LIFE
It is also important to consider the
psychological impact of having
a stoma, which can impair the
patient’s body image and general
wellbeing, as well as his or her
confidence (Swan, 2010). A study
of 140 stoma patients by Richbourg
et al (2007) found that 53% had
depression or anxiety and 54% were
not as socially active as they were
before the procedure.
There is evidence that
peristomal complications and skin
irritations substantially reduce
patients’ quality of life (Prieto et
al, 2005; Williams, 2007), and it is
certainly true that some people
react negatively when informed that
they may require a stoma (Swan,
2010). The procedure not only
affects the person’s body image, but
also their feelings of ‘cleanliness’
and good health, and the way they
perceive society views them.
‘Adhesives work by knitting
into the skin’s top layer
and when adhesive tape
or substances are removed
they inevitably strip a certain
amount of the stratum
corneum.’
Answer the following questions
about this, either to test the new
knowledge you have gained or to
form part of your ongoing practice
development portfolio.
1 – What are some of the skin-related
complications involved in having
a stoma?
2 – Why is leakage a problem for the
peristomal skin?
3 – Can you explain why skin stripping
occurs?
4 – Name some of the main techniques
for helping to avoid peristomal
skin complications.
5 – What is the effect on the patient’s
quality of life of peristomal skin
complications?
Five-minute test
Leakage
Containment of effluent substances
are a consistent problem for the
patient with a stoma, with up to
50% experiencing leakage (Raitliff
et al, 2005). Peristomal skin damage
from effluent substances actually
increases the risk of leakage
(Rudoni, 2011), rendering the
skin more vulnerable to further
damage and creating a cycle of
harm, where effluent substances
damage the skin, making
application more difficult.
The nature of the effluent
contained within the stoma
means that the peristomal skin is
particularly vulnerable to damage.
When the raised pH levels and
increased moisture of urine and
faeces come into contact with the
skin, the result is maceration, which
can begin to erode the epidermis
(Williams et al, 2010). These effects
are exacerbated in ageing skin due
to structural changes including
(Butcher and White, 2005; Stephen-
Haynes, 2008):
Decreased sweat glands
Reduced vascular function
Thinning of the epidermal layer
Reduced skin elasticity
Slower healing.
1...,64,65,66,67,68,69,70,71,72,73 75,76,77,78,79,80,81,82,83,84,...116