The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [203]
9 Once the suppository(ies) has been inserted, clean any excess lubricating jelly from the patient’s perineal area. To ensure the patient’s comfort and avoid anal excoriation (Moppett 2000, E).
10 Ask the patient to retain the suppository(ies) for 20 minutes, or until they are no longer able to do so. If a medicated suppository is given, remind the patient that its aim is not to stimulate evacuation and to retain the suppository for at least 20 minutes or as long as possible. This will allow the suppository to melt and release the active ingredients. Inform patient that there may be some discharge as the medication melts in the rectum (Henry 1999, E).
Postprocedure
11 Remove and dispose of equipment. Wash hands. For infection prevention and control (Fraise and Bradley 2009, E).
12 Record that the suppository(ies) have been given, the effect on the patient and the result (amount, colour, consistency and content, using the Bristol Stool Chart – see Figure 6.1) in the appropriate documents. To monitor the patient’s bowel function (Gill 1999, C).
13 Observe patient for any adverse reactions. To monitor for any complications (Peate 2003, E).
Stoma care
Definition
Stoma is a word of Greek origin meaning mouth or opening (Taylor 2005).
Anatomy and physiology
The gastrointestinal tract stretches from the mouth to the anus (see Figure 6.11). It is responsible for absorption of carbohydrates, proteins, fats, water, electrolytes, vitamins and bile salts.
The small bowel is divided into three sections: the duodenum, the jejunum and the ileum. Its primary function is digestion and absorption of nutrients, vitamins, minerals, fluids and electrolytes.
The colon (large bowel) consists of the caecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anal canal. It is about 1.5–1.8 metres long and approximately 6 cm in diameter (Thibodeau and Patton 2007a). The colon has four main functions (Nazarko 2007).
Reabsorption: around 1 litre of water in 24 hours and bile salts that are secreted from the liver to enable digestion to happen.
Creation of vitamins and biotin: the bacteria in the colon form vitamin K, essential for blood clotting, vitamin B5, necessary for the manufacture of neurotransmitters and hormones, and biotin, a substance required in glucose metabolism.
Elimination: of indigestible residue of food and excess metabolites.
Formation and storage of faeces: as the end-products of digestion pass through the colon, they become thicker and more formed and are stored in the colon until they can be eliminated.
The rectum and anal canal include internal and external sphincters which are the mechanisms responsible for controlling bowel function. Therefore disturbance of this results in loss of bowel control and incontinence.
An understanding of the relevant anatomy and physiology is key to understanding the functions of different types of stoma formation.
Related theory
Approximately 13,500 people undergo stoma formation surgery every year in the UK (Baxter and Salter 2000). The most common underlying conditions resulting in the need for stoma surgery are colorectal cancer, bladder cancer, ulcerative colitis and Crohn’s disease. Other causes of stoma surgery include:
cancer of the bowel
cancer of the pelvis, for example gynaecological cancer
trauma
neurological damage
congenital disorders
ulcerative colitis
Crohn’s disease
diverticular disease
familial polyposis coli
intractable incontinence
fistula
radiation enteritis.
Therefore stoma surgery affects many people regardless of gender, age