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.
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