Tuesday, September 25, 2018

Assessing And Managing Stomal Complications

Stoma complications can occur at some point after surgery in some patients. It is the job of nurses to assess the problem quickly, provide an effective solution, and refer the patient to the doctor if necessary.

According to a survey conducted in the year 2002, about 73% of people with a stoma have face skin problems, and about 66% of them try to resolve those problems without consulting to a nurse. Nurse involvement gets necessary in a situation where a patient doesn’t seek help.

Assessment

The job of the nurse is to carry out a detailed assessment before treating the problem. This assessment includes checking symptoms and observing the stoma and the peristomal skin. They also need to get information about how long the problem has been there and any treatments tried in the past. If the problem is not resolvable at the moment, they should refer the patient to the doctor.

Sore skin

One of the most common problems that occur with a stoma is skin soreness. Its symptoms mainly include red skin, which is usually intact. The worsening of this problem can lead to the breakdown of skin, causing skin ulcers. Before starting the treatment, the nurse has to assess the real cause of the problem. The most common reason for skin redness is the skin’s contact with the stomal output.

Another reason for the sore skin is the frequent removal of the skin barrier. This frequent pulling of the skin barrier can cause discomfort to the peristomal skin.

If you have a colostomy, but you have frequent stools, you may want to use a two-piece ostomy pouching system to avoid changing too many skin barriers during a specific period.

Difficulty removing the ostomy appliance

Some people find it difficult to remove the ostomy appliance, resulting in them pulling the skin barrier too hard. It can cause skin stripping, which can be quite painful. Nurses should teach such patients to be gentle with the removal of the skin barrier. Using adhesive remover sprays or wipes can make the removal of the ostomy skin barrier easier. The adhesive remover is particularly useful when the patient has to get rid of the residue left after the removal of a skin barrier.

Appliance leaks

A survey report suggests that about 85% of the patients with ostomies face the problem of leakage. There can be several reasons that can lead to the leakage of a stoma appliance. The most common reason is the ostomy appliance getting too full before the patient replaces or empties it. Teaching patients to change or empty the ostomy appliance when necessary can rectify this issue.

The stoma output that is too watery can leak under the skin barrier. If the problem has been persistent for some time, you may want to give the patient stool thickening medication. A dietary change may also serve the purpose.

The unevenness of the peristomal skin is also the reason for the leakage to occur. The skin barrier fails to form a proper seal with the skin in this regard. Using a stoma seal may help prevent leakage. Another way is to use a convex skin barrier, which has the protruded side that goes against the skin.

Sunday, July 8, 2018

How To Conceal Your Ostomy Appliance

An ostomy appliance peeking through underneath the clothes is one of the significant concerns that most people with ostomies have. In this article, we will talk about ways to conceal your ostomy appliance under your clothes.

 

The type of ostomy appliance you wear may be more noticeable than others. It is mainly about how far the pouch is sticking out from your skin. Generally, a two-piece ostomy pouch sticks out more than a one-piece system. The coupling mechanism used in a two-piece ostomy system adds significantly to the amount of hardware used in the system. The good news is that companies have been working on the development of lower profile 2-piece systems that tend to remain discreet in the same as a one-piece ostomy system. This variety of ostomy pouches is available in the market, but it might not be suitable for individuals who need convexity. You may want to talk to your ostomy care nurse regarding whether this option suits you.

Another way to conceal your ostomy appliance is to modify your clothing choices. You don’t have to stick to loose-fitting clothes, as there are a lot more options you can consider. You may opt for clothes that have color patterns. Certain patterns do well to hide the bulge of your ostomy appliance almost entirely. Generally, you will want to wear clothes with dark colors to conceal your ostomy pouch. Men can wear suspenders instead of tight belts.

 

Most people are concerned about their ostomy bags getting visible due to tighter swimming suits. This situation causes them to shy away from swimming, which can be a beginner activity for an ostomate to build enough strength to start a fitness regimen. Swimming suits are tight enough to allow a bulge to occur at the site of the stoma bag. Again, wearing dark-colored swimsuits or the ones with patterns may help you conceal your pouch. You can consider wearing surfer type shorts, which have longer legs and rise in the crotch. If you have an intestinal stoma, you may be able to predict the schedule of your stomal output. Even better, you can set a schedule for bowel movements. It will allow you to wear a small bag or a stoma cap while swimming.

 

The location of the stoma matters a lot when it comes to concealing your ostomy bag. Generally, the ET will want to mark the stoma site above or below the beltline. It means that you may have a choice to select a site for your stoma. You can talk about it with your doctor or ET.

Thursday, July 5, 2018

Appliance Wear-Times: Factors To Consider

Individuals with ostomies generally think of wearing their ostomy bags for seven days. However, there is no standard set for wear-time for ostomy appliances. There are several factors to consider when determining the wear-time.

  

Stoma type

The consistency and frequency of your stomal output depend on the type of stoma you have. For instance, ileostomies tend to produce a liquid or pasty stool, and they function 5-6 times a day. Colostomies produce thicker stools, and they function fewer times a day. Stool with liquid consistency has more digestive enzymes, which are corrosive enough to contribute to melt-out of the barrier. A skin barrier no longer adheres to the skin after melting out, resulting in skin irritation. You are going to have to change your ostomy pouching system just before that melt-out.

Stoma age

How often you should change your ostomy pouch also depends on the age of your stoma. If your stoma is a newly constructed one, it will have swelling, and it will cause a lot of moisture in the skin around it. The swelling subsides in six weeks. During this time, the stoma changes its shape more frequently. After this duration, the stoma settles down to a permanent shape and size. During these six weeks, your ET will suggest you change your pouch twice a week every week.

Characteristics of stool

Generally, the more liquefied the stool is, the more frequently you are going to have to change your pouch. The stool output from an ileostomy can be more frequent. You may have to empty your pouch several times a day. With a colostomy, the stool tends to be more firm and less frequent. However, there are certain health conditions and treatments that can permanently change the characteristics of stool passing through a colostomy. Again, it all comes down to the tendency of the stool to cause melt-out of the skin barrier. The sooner the skin barrier melts out, the sooner you will need to replace it.

Stoma construction

A well-construction stoma is the one that protrudes appropriately, and the skin around it is plain enough to allow proper adherence to the skin barrier. In some cases, the stoma might not have enough protrusion, or the skin around it has creases. With these issues, it becomes a challenge to apply the ostomy pouch. It can reduce the wear-time significantly.

 

Type of product

The type of product you use also has a significant impact on the pouch’s wear time. The skin barrier of the pouch you purchase will either be regular wear or extended wear. Regular wear skin barriers do not offer much resistance to melt-outs, and they have less adhesion on their baseplate. These skin barriers are best for users who have colostomies that produce more formed stool. Depending on the protraction of the stoma and the state of peristomal skin, these skin barriers can last up to seven days.

Extended wear skin barriers, on the other hand, offer more resistance to melt-outs, and they use a significantly strong adhesive on their baseplate. These barriers are ideal for people with ileostomies that produce unformed stool that contains a significant amount of corrosive digestive enzymes.