Saturday, June 30, 2018

HOW TO HELP THE PATIENTS WITH OSTOMY: ALL THE THINGS AN OSTOMY TRAINER MUST KNOW

Patients who have undergone ostomies become very vulnerable and over-sensitive. They do a lot of negative thinking. They are frustrated about everything. They always remain sad thinking about the sudden change in their life and body. They consider themselves unlucky because their fate and body have been changed dramatically. They want everything the same as it was in the past. They become very insecure about their body and fear going to public places.

It is very important to support Ostomy patients in this hard time. You can help them to cope with their fears and anxieties. You can contact an Ostomy nurse or COCN, They will help you to manage your problems. But your cooperation is needed.


For instance, a patient is told many times that the odor can be reduced, but if the staff enters the room and they spray deodorant in the room that means that there is a leakage. If the filter is also active there should be no odor. In this case, the patient is taught about the factors that can cause odor and the patient is explained how to control the odor and avoid any kind of leakage. In case when a pouch is being drained or there is a leakage there are chances of the odor, but if the pouch is secured in its place then there should be no possible odor. Your good humor can work with some patients but in some cases, you need to be serious.

In this world nobody is perfect. So there is a possibility that you may not get any pre-operative Ostomy nurse or you don’t have any pre-surgical sitting with your doctor. This might be possible due lack of awareness or when your surgery is performed in an emergency. As we know that technology has advanced very much in the field of medicine a patient is allowed to leave the hospital after 2 to 3 days following the surgery.

Because your time with a patient is limited, it'll be critical to make every minute worth it. Match your instruction to a student's preferred learning style wherever possible. You can inquire about a patient's preferred method of learning, although most patients will be unaware. As well as being a competent detective, rely on models based on age-appropriate learning. There are some hints. Have you paid attention to your patient's reading? If this is the case, printed materials should be used. Is their phone usually close at hand on the nightstand? If that's the case, they could prefer videos. Make the most of your time with patients and teach them at every opportunity.

Teaching should be more fundamental. You can start with the basic information. Always try to keep it easy and simple:

  • An Ostomy is a hole that a surgeon creates in the abdominal wall for the removal of feces or urine.
  •  A a portion of the small or large intestine that can be seen on the abdomen is called stoma
  •  Stomas are examples of mucosal muscles. Similarly, mucosal muscles are present throughout the GI tract and anus.
  •   Patients should be encouraged to touch and look their stoma
  •  There are a number of reasons that can lead to the Ostomy such as cancer, abdominal injury, genetic issue
  • An Ostomy is termed as the name of its location. For example, colostomy involves the colon, ileostomy involves the ileum and urostomy involves the urinary system.
  •  People who have undergone Ostomy are absolutely normal. They can lead a proper and prosperous life. Ostomy can’t stop them

 

How to change a pouch

Besides basic pouching systems, there are many other varieties and sizes of pouching systems

Ostomy changes life dramatically, but don’t stop here. Life is all about moving on.

If you are an Ostomy management and care trainer then you will be teaching your patient about how to drain their bag and how to change your bag successfully. This is a hard step for the patient. They may have anxiety about this and fail many times but with every passing day, they will become experts. Encourage the patient with every little step forward

How to start:

Before you start, ask your, patients, to collect all the necessary supplies near them. The things those are vital for the cleaning purpose such as wipes, moist clothes, towels, measuring card. Scissors are also needed in case of any type of cutting. On your discharge from the hospital, you may get many samples of Ostomy products. All of them are used for a specific purpose. But it is recommended to use as much fewer products as you can. Help out your patients to make things and their Ostomy easy for them

Removing the pouch:

When all the supplies have been gathered, remove the current pouch gently. Some patients remove their pouch while showering but some prefer to remove it in the washroom with the help of all the supplies. Start with gently pushing down your skin, using a warm and hydrated towel, and lift the upper end of the pouch. Start from the top and move downward in order to avoid any feces or urine in the old pouching system. Once the pouching system gets detach from the skin place it in a discarded bag or in the dust bin. Don’t close the mouth of the bag because you may need to discard anything else later. When the abdomen is all clear encourage the patient to have a look at their stoma.

If you have a large amount of hair around the stoma, you can shave or clip those hairs. It will make stomal cleansing easier and you can have a better look at the stoma. Teach your patients about the stoma size. In beginning, the stoma is swollen but with every coming day edema is gone and the stoma will regain its normal size. So it’s necessary to keep a record of stomal size.

It is very necessary to clean your stoma properly. Any kind of filth can cause infection. Some people prefer to do the cleaning in the shower when they have not been wearing a pouching system. Use plain tap water for cleaning. Avoid using soaps, baby wipes, or any other oily products it will affect the adherence of the pouching system. You can use a fan or a hairdryer to dry the soma in no time.

How to apply a pouching system:


After measuring the stoma, you need to cut a hole that is according to the size of the wafer. If you are using a one-piece pouch then prevent the plastic from being cut along with the barrier. You can use a stoma paste for better results. Always keep in mind that stoma paste is only a caulk, not an adhesive. You can teach your patients that they need to gently put pressure on the stoma and the pouching system this will allow a better sealing.

Changing the pouch

The changes are updated every 7 to 8 days and depend on the d=following factors:

        Patient’s preference

        Type of stoma

        Nature of the effluent

        Type of the pouch

The patients with colostomy and well-formed feces use a closed-end pouch that they can change with every bowel movement. Usually, they need to change one or two times a day. If a patient feels itching, irritation, odor, or any leakage he should the pouch immediately rather than waiting for the next bowel movement.

Teach your patients step by step. Encourage them with every successful step.

Teaching is not all about teaching how to change or manage a pouch. As an Ostomy nurse, you can help your patients to choose the Ostomy accessories and supplies that are best for them. They can find the Ostomy supplies easily at any special pharmacy, online brands, etc.

Lifestyle Discussion

In addition to the basic information you also have a responsibility to teach the patients how to live their life without any worries. This involves draining a bag when it almost 1/3rd filled. Always keep an extra pouching system, in case of traveling. Patients should remember about the surgery and not lift weight more than 10 pounds, as it may develop a hernia.

Nutrition also plays a very crucial role in the healing process and time. It is recommended to take 30cc/kg/day each day.

There are some foods that can cause gas such as broccoli, cabbage, capsicum, corn. It's good if the food is taken in small quantities throughout the day. Try to drink plenty of fluids.

Sexuality is a very crucial and demanding part of human life. While discussing Ostomy, be open talking about sexuality. Patients may feel comfortable talking about this, but you should start this topic to make them comfortable. Discuss the concerns they might have. This topic needs discussion despite gender, age, and marital status.

Eventually, the patient will learn how to manage the Ostomy and how to make their life productive despite the Ostomy.


HOW DIET CAN AFFECT YOUR ILEOSTOMY OR COLOSTOMY?

For the patients who have undergone ileostomy (stoma created through ileum) or a colostomy (stoma created through colon), a well-balanced and well-maintained diet is very necessary. Diet can affect the healing process. If a patient takes a good diet he or she can recover sooner. A better diet can help you to reduce the other complications that might occur after surgery.

In both cases, there is excess loss of fluids in the body. This is because of the Ostomy. Since water is reabsorbed by the colon, after the surgery it is very difficult to maintain the percentage of water.

Usually, it is advised to a colostomy and ileostomy patient to take two liters or 8 cups of fluids throughout the day. Water is the best choice and patients should avoid drinks with a higher ratio of caffeine i.e. Colas, strong tea, or coffee.

Patients of both groups should not shorten the amount of salts in their diet. Salts that are reabsorbed in the colon also can’t be reabsorbed after an ostomy. Especially the patients with an ileostomy should take extra salt to prevent dehydration. And persons with colostomy do not need to take a large amount but a moderate amount is necessary for the compensation.

If the ileum has been removed more than 100 cm during the ileostomy then you should take supplements like B2 vitamin, A, D, E and K. Consult your doctor, before adding them to your diet.

Ostomy can cause issues like diarrhea, odor, gas, constipation, or bowel obstructions. Many people can enjoy a normal diet, but in case of any other complications, adjustments are needed.

Diarrhea

After ileostomy the feces formation is very loose, feces are in liquid texture. That’s why in this condition if there are more than 1000 ml of loose feces output then it is considered diarrhea. In the case of colostomy, diarrhea is explained as frequent and thinned feces. Following tips can help you to control diarrhea:

        You should increase your liquid intake up to 2 and half liters throughout the day

        You should take food that thickens the feces such as applesauce, bananas, yogurt, rice, and oatmeal

        Avoid food items that trigger diarrhea such as prune juices, alcohol, cauliflower, Brussel sprouts, and capsicum.

        You should intake extra salt and eat more salty foods.

        You should eat foods that have a higher ratio of potassium such as bananas, tomatoes, potatoes, meats, and dried fruits.

Constipation

Constipation is a condition that is seen only in colostomy patients. It does not occur in ileostomies. The following tips can help you to avoid constipation:

        you should drink 2 and a half-liter or 10 cups of water throughout the day.

        you should eat foods that are rich in fiber such as bran, fruits, vegetables, and whole grains. Prune and prune juices can also prevent constipation.

Odor



Odor is a common problem following surgery. It is very awkward and embarrassing if there is an odor due to your ostomy, especially when you are in public places. There are some foods that can trigger the odor. In order to avoid odor you may need to:

      Avoid the food items that increase odor such as broccoli, cauliflower, turnip, Brussel sprouts, legumes, garlic, onion, etc.

      Increase the intake of foods that reduce odor such as parsley, yogurt, buttermilk, cranberry milk, etc.

Gas

Gas can be caused easily following a surgery. There are some foods that can cause a lot of gas in your ostomy. Gas can be caused due to:

        Swallowing air

        Eating chewing gums

        Using carbonated drinks and beverages

The foods that you should avoid are:

        Broccoli

        Capsicum

        Higher fats containing foods

        Food with higher proteins

        Foods with a high level of caffeine

Blockage or Bowel obstruction

Ileostomies can be a reason for bowel obstruction or blockage in many people. If you have no bowel movement or output for the last 12 hours then it indicates that a blockage is already there. In order to avoid blockage please follow these instruction given below:

You should drink 2 and a half liters or more water throughout the day.



You should take only small quantities of high fiber foods following surgery. Avoid or use the foods with precautions that have seeds and peels.

Conclusion

People who have undergone ostomies can take a normal diet but it should contain an adequate quantity of liquids and salts. Trying a new food especially the one which can cause diarrhea, odor, and blockage, or constipation, only one item should be tried at once. You should have awareness of the problem and its treatment. This would help you to live with an ostomy.