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Ostomy: Basics, Skin Care and Nursing

Ostomy: Basics, Skin Care and Nursing

Ostomy Basics

An ostomy is a surgery in which an opening is made in the abdominal wall to allow the discharge of body waste. Depending on the patient, it can be performed as a short-term or long-term solution.

This surgery is recommended when the body has been affected by conditions related to the gastrointestinal or urinary system.

Some of the conditions that can lead to an ostomy are:

  • Bowel Cancer
  • Bladder Cancer
  • Gynecologic Cancer
  • Chronic inflammation of the digestive tract

There are cases in which this procedure is performed to protect the patient from a life threatening situation, such cases include:

  • Severe injuries which have developed suddenly
  • Difficulties arising from exposure to radiation
  • Inflammation or infection of the diverticula
  • Obstruction of the bowels because of its own torsion
  • Necrotizing enterocolitis
  • Ruptured bowel

Stoma is the term used to describe the part of the gastrointestinal tract that is used as route for waste to escape from the body. The part of the gastrointestinal tract that is used for the stoma can vary.

According to the section used, a stoma can be classified as:

  1. A colostomy
  2. A Ileostomy
  3. A Urostomy

A colostomy occurs when the large bowel is employed. There are instances in which the small bowel is extracted partially during this surgery, however it isn’t always the case.

An ileostomy has taken place when the small bowel is used to create the stoma, in some occasions this process might also involve the large bowel.

While an urostomy is performed when the intestines are used to allow the discharge of urine. During this procedure the tubes that carry the urine are attached to the intestine to reroute this fluid.

The prominence of the stoma can differ in each patient. The ideal opening is one that sticks out from the surface, since those that are pulled into the body are often the origin of many health issues. Whereas those that are at the same level as the skin might cause some difficulties, although it isn’t always the case.

The place in which the opening will be located is of extreme importance and requires proper analysis. It is the job of the doctor or specialized ostomy nurse to detect and indicate the proper placement of the stoma.

For proper stoma placement, the patient’s midriff should be evaluated from different positions to look for skin protuberances that might interfere with the stoma.

Once an ostomy has been performed, the patient will need some type of container to collect body waste. These containers are known as pouching systems. They are available in different kinds in order to adapt to the requirements of different ostomates.

In order to pick one that suits the patient’s needs, it is necessary to assess factors such as the place of the opening, the state of the skin surface, the patient’s personal choice, the patient’s physical qualifications and the properties of the opening.

It is also important to take into account whether a colostomy, an ileostomy or an urostomy was performed. It might be necessary to experience with different pouching systems before finding the ideal one.

Selecting the place for the stoma, carrying out the ostomy surgery and getting a pouching system might not be the whole process. There are certain difficulties that might arise with this opening after the procedure is done, such as:

  • Necrosis in the stoma

Is the death of skin tissue characterized by a lack of blood in the area of the opening. When it reaches underlying tissue beneath the skin a visit to the doctor is often recommended. The level of severeness can be easy to detect since the more severe it is, the more noticeable it will be. If it is critical, the stoma usually pulls back.

  • Hemorrhage in the stoma

Bleeding in small amounts after the surgery is not unusual. However, it is important to discuss this with the doctor to find the root of the hemorrhage.

  • Prolapse of the stoma

It happens when the bowel sticks out from the stoma. When the condition becomes severe surgery might be necessary.

Ostomy Skin Care

When the baseplate of the pouching system is detached from the skin it is helpful to dampen it by using water or an adhesive remover.

To keep the patient’s skin clean, he or she should rinse the area before attaching the pouching system. Non-sting alcohol skin products can be employed to prepare the area, although it is not a requirement.

When living with a stoma, skin might become inflamed or infected due to several reasons, for instance:

  • The appliances used to treat the opening might cause contact induced allergies. To deal with this issue, the brand of pouching system used could be changed for another one or a baseplate that does not require adhering appliances for attaching could be employed.
  • A person can also experience inflammation due to the presence of fungus. This can be treated by a using a small amount of nystatin topical powder.
  • The patient might have to come to terms with harm to the skin due to constant contact with waste. In this case, make sure to avoid leakage by adjusting the position of the pouching system.
  • The ostomate might also have to deal with folliculitis. To care for this condition, products that destroy damaging microorganisms should be employed.

Ostomy Nursing

When it comes to the pouching system, there are nurses that are hesitant about the dimensions of the ostomy baseplate. Nurses should make sure that this appliance is wide enough to match the dimensions of the stoma in order to avoid injuring the opening.

The stoma acquires its permanent size once approximately 4 months have passed after the procedure. Therefore, the baseplate should be adapted each time the stoma changes sizes during that period of time.

An ostomate can experience a great deal of emotions afters this procedure. These emotions will vary according to the ostomate’s state of mind. If patients react positively to the surgery it is like that the nurse will share this sentiment, however the nurse might be affected emotionally if the patient reacts negatively.

When the outcomes do not inflict any type of emotion on the nurse, it is probable that he or she:

  • Does not know how to engage with the patient
  • Is new to the profession
  • Has not been able to engage with the patient

Just as patients can affect nurses emotionally, it can also occur the other way around. Factors such as the time dedicated to the ostomate’s care, the lack of proper equipment and the feelings a nurse has towards the procedure can all aid or delay the person’s recovery process.

The physical and psychological consequences of an ostomy might have an impact on the nurse’s ability to help the patient lead a successful healing process.

Among the physical difficulties are the underlying health disorders that a patient might be suffering from. In order to detect potential complications in the sight, a test measuring the clarity of vision should be conducted.

Issues that might appear mundane on the surface, such as extreme tiredness, should be assessed as well. The early detection of health conditions is important in order to fit new requirements and needs in the nursing care plan.

A patient can go through a range of emotions after an ostomy is performed. There are occasions in which the patient will feel extremely happy that the surgery is done, however there are others who experience an overwhelming sense of shock.

The ostomate’s negative response to the procedure might arise because of the way it alters the body physically. A patient can feel insecure and ashamed about living with an stoma.

He or she might feel deprived from sexual behaviors and an overall healthy lifestyle. In these cases, it is important to allow the patient to share these emotions since talking about a concerning subject might bring about a sense of relief and ultimately acceptance.

Nurses usually manage the information of self-help groups and are capable of conducting the patient to one. Nurses can also direct patients to other medical specialists, these include psychiatrists, therapists, social workers, and specialized ostomy nurses.

In some instances, a nurse might introduce the patient to people who have been through the whole ostomy process and have the desire to share their experience with someone who is new to it.

The partnership that arises between the patient and the nurse plays an important role in the recovery process. Both should be honest and be able to count on one another.

Although ostomates can suffer from an overall bad mood, the nurse should be able to empathize with the patient in order to move through an issue. The nurse should try to set a positive environment by providing emotional support to the ostomate at all times.

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