NRC | November 2016, vol 18, no 11 3 CLINICAL REVIEW © 2016 MA Healthcare Ltd D ue to the increasing ageing population in the UK, along with improved clinical outcomes for diseases such as cancers and inlammatory bowel diseases, there will be a likely rise in the number of older people with a stoma in the near future. As a result, it is important that health professionals possess adequate knowledge of how to care for patients with stomas, and an understanding potential complications that may occur (Ebersole and Hess,1998; Black, 2014). The aim of this clinical review is to highlight the importance of appropriate stoma care in a residential care setting, to identify the main problems that can occur and the issue of reduced luid and nutritional absorption in those who have had parts of their bowel resected. What is a stoma? A stoma is a section of the bowel that is brought through the abdomen to sit on the outside of the body. This is done in order to re-route excretion of faecal matter or urine (Black, 2014; Burch, 2015). There are numerous reasons why an older adult may have a stoma formed. These include bowel and bladder cancers, diverticulitis, or other inlammatory bowel diseases (Burch, 2015). A stoma means ‘mouth’ or ‘opening’, and can be surgically formed from different parts of the internal organs, to link either different parts of the bowel or ureters to an outer ‘pouch’ to enable excretion of waste products (Burch, 2013). There are three common types of stoma formations, colostomy, ileostomy and urostomy. Stomas are positioned at different sites, depending on which surgery has been performed (Burch, 2013). These sites are important to the clinician, as they will determine the excreted product and therefore the level of care required to manage the stoma (Figure 1). Types of stoma Ileostomy Ileostomies and ascending colostomies are found on the right-hand side of the abdomen. They are created from the bowel at points where water reabsorption is still taking place, allowing stomas on the right side of the abdomen to excrete loose stools. Colostomy Colostomies may be on the upper aspect of the abdomen (at the transverse colon), or on the left-hand side (descending colon). Stomas are formed during surgery and their position is dependent on the amount of bowel that requires resection or removal. Descending and transverse colostomies are fashioned from the large bowel, so formed stools are passed. Urostomy Urostomies are a different type of stoma. They are generally created because of bladder or ureter cancers in order to divert the low of urine (Nazarko, 2014). They are formed by transposing the ureters into a conduit of small bowel which is then brought out onto the abdomen (Black, 2000; Burch, 2008). Urine that passes through a urostomy differs from urine that is passed in the conventional way, in that there may be mucous present, and will contain more bacteria due to passing through the bowel. The risk of backlow is also increased, as a result of the absence of uretic sphincters, increasing the risk of infection (Williams, 2012). To combat this, urostomal appliances have integral valves to prevent backlow of urine. In addition to urinary tract infections, patients with urostomies also subject to the same problems as all ostomates (people with stomas). They will need observation to prevent complications, such as: damage An ageing population and improvements in clinical outcomes of surgery means that care providers will see an increase in the number of people with stomas. In this article, Joanne Cremen and Amanda Lee describe the appropriate management of these residents An overview of stoma care in the residential setting Joanne Cremen Nursing Student, University of Hull j.l.winney@2014.hull.ac.uk Amanda Lee Lecturer, University of Hull a.j.lee@hull.ac.uk