The nurse is assessing for stoma prolapse in a client with a colostomy. The nurse would observe which of the following if stoma prolapse occurred?
A. Sunken and hidden stoma
B. Dark- and bluish-colored stoma
C. Narrowed and flattened stoma
D. Protruding stoma
Correct Answer: D. Protruding stoma
A prolapsed stoma is one which the bowel protruded through the stoma. Prolapse is a complication associated more with colostomies than with ileostomies, and is more frequent in those with loop colostomies, particularly loop stomas located in the transverse colon, than with end stomas. (End stomas result from a complete cut through the intestine with the end pulled through the abdominal wall, while loop stomas result when an intestinal loop is pulled through the abdominal wall and an incision made into part of the loop.)
Option A: A stoma retraction is characterized by sinking of the stoma. Stoma retraction is caused by excessive tension on the bowel or stoma placed at a poorly selected site. Stoma retraction can lead to skin irritation and improper fixation of the stoma appliance. In mildly symptomatic cases, a convex faceplate and a tight belt may be used to control leakage around the appliance.
Option B: Ischemia of the stoma would be associated with a dusky or bluish color. Signs of ischemia usually arise within 24 hours. The stoma first appears edematous with bluish discoloration and then progresses to necrosis. A common cause of ischemia is an inadequate arterial blood supply secondary to damage to or an inappropriately divided vascular arcade supplying the left colon.
Option C: A stoma with a narrowed opening at the level of the skin or fascia is said to be stenosed. Stoma stenosis is the narrowing or constriction of the stoma or its lumen. This condition may occur at the skin or fascial level of the stoma. Causes include hyperplasia, adhesions, sepsis, radiation of the intestine before stoma surgery, local inflammation, hyperkeratosis, and surgical technique.
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