Integrate Stomal theory into clinical practice using a case analysis format.

Having progressed through the learning guides for themes 3, 4 and 5 you should be familiar with the management of the patient with a stoma, including pre and post-operative education and support, stoma siting, stoma products, and psychosocial and cultural issues that may present as a barrier to adaptation.

The purpose of this assessment is to assess your ability to integrate theory into clinical practice using a case analysis format. This assessment relates to theory across all themes in this subject. For this assessment you will be given an evolving case scenario with intermittent questions/points to discuss.

Case scenario:

Fred is a 66-year-old man who presents to the preadmission clinic with a low rectal cancer. He has been told that he will need to have an operation to remove the cancer and the surgeon has told him he will need either a temporary or permanent stoma. The surgeon intends to carry out the operation laparoscopically, however Fred has been made aware that sometimes this operation needs to be converted to an open procedure for several reasons.

Fred states that he is resigned to his situation and just wants to get things over and done with. He is newly widowed and stated that he was having problems looking after himself as his wife had carried out all of the cooking and housework and his only daughter lives interstate.

• Discuss the stomal therapy assessment, education and interventions that you would provide for Fred preoperatively.
• Include examples of diagrams and/or photographs that you may use in your patient education for anatomy/surgical procedures/stomas etc, and describe how you would explain this to him in terms he would understand

One of the interventions required is selection of a stoma site. Fred will need to be sited for both a colostomy and loop ileostomy.

• Outline the principles of stoma site selection
• Discuss the differences between colostomy and loop ileostomy and provide a rationale for why education about both stoma types needs to be addressed with Fred.

Fred returned from the operating theatre following an open Abdomino-Perineal Resection of the rectum (AP Resection). The tumour was larger than initially thought and the surgeon had problems carrying out the procedure laparoscopically and had to convert to an open procedure.

• Analyse the immediate postoperative intervention required for Fred focusing on stoma and wounds.

Two days later Fred is keen to commence stoma education.

• Develop and discuss an education plan for Fred with achievable goals in order to work towards discharge. This needs to include appliance selection, rationale for choice of appliance, support services and follow-up.

Fred has been told that he will need further treatment as his pathology report stated that he had a Dukes C tumour.

• Outline one of the staging systems used in colorectal cancer. Discuss any issues Fred may have during Radiotherapy and Chemotherapy that may affect his stoma.

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