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Volume 31, Number 7 April, 2004
CARING FOR “EXCORIATED SKIN”
By: Diane Duran, MSN, RN, CWOCN, NY.
If, after removing your wafer, you find your skin to be red, denuded of skin, painful or sensitive, you have “excoriated skin”. Excoriated skin is often caused by pulling at your wafer too vigorously, along with moisture your wafer, use a non-alcohol adhesive remover. Simply hold down your skin with the adhesive remover pad and going from side to side, gently pull your wafer down and away from your skin. After gently washing the stoma and surrounding skin with warm water, dry the skin thoroughly. Sprinkle the skin with
Stomahesive powder, dust off the excess and seal the powder in with a non-alcohol containing skin prep. Wipe the skin with the skin prep until you can’t see any more powder. Then instead of placing your wafer squarely on your skin, put it on “diamond” shape. The next wafer change, put it on your skin squarely and rotate every other change. This gives at least part of your “excoriated” skin a good chance to heal. Remember, be gentle with your skin and it will be good to you!!!
THE BEST MEDICINE
Via:“The Pouch” Northern VA, Chapter & Vancouver Highlife
A year or so after my ostomy surgery, ever-increasing pain in the abdominal area led me to my doctor, who diagnosed my symptoms as that of kidney stones.
The urologist successfully removed the stones with a little umbrella-like instrument he inserted into my penis. I was quite recovered in a day or two. As I talked with my doctor afterwards, he said, “Do you get thirsty often?” I replied, “No.” “There’s the reason for your kidney stones, he replied. “Water is essential for everyone and ostomates need more than usual because they’ve lost so much of their intestinal absorbing area. The best medicine I can recommend is water. When you are thirsty, don’t drink just enough to alleviate your thirst. Drink a glassful and
drink a glassful often. Never pass a drinking fountain without taking a drink.”
As I’ve followed his advice, I’ve had no recurrence of stones and have been grateful over the years for “the best medicine.” Reading up on the subject, I’ve discovered that water not only helps us get rid of wastes, but is vital for digestion and metabolism, helps us keep cool through perspiration, lubricates our joints, moistens our lungs so we breathe better, and even helps us lose weight. Water helps to metabolize fat, and if you’re not getting enough water, your body will retain what it has, thus keeping your weight up. Normal people need eight to ten glasses throughout the day and evening.
SELECTING OSTOMY EQUIPMENT
Via: Genesee Valley Ostomy Assoc. Rochester, NY
The following should be considered when choosing the type of pouching system for the ostomate, One-Piece versus a Two-Piece.
When might a One-Piece work better than a Two-Piece?
* When the patient’s eyesight is poor or if their hands are shaky.
* When the patient is a youngster who is just learning to care for himself/herself.
* When the new patient is depressed or uninterested and clearly will not be bothered with assembling anything.
* When the stoma is flush with the skin and a particular one-piece appliance
offers the proper convexity in the faceplate for obtaining the best seal
When might a Two-Piece be better?
* When the patient wants to put the faceplate over the stoma first, which allows them to be sure that the stoma is correctly centered. (This is particularly helpful when the stoma is irregular in shape and the faceplate opening has been tailored to fit.)
* When it is necessary to provide a very small face-plate to avoid contours such as scarring, depressions, or high spots on or near the surrounding area. There are manufacturers who make pouches to meet those needs as well.
* For situations where a particular two-piece offers less silhouettes or bulges under clothing.
* When the doctor or patient wants the pouch to be changed daily for cleaning. With a Two-Piece, this can be accomplished with ease while the flange remains securely in place on the body.
HEALTH CARE AND OSTOMIES
By: Peggy Christ, CWOCN & Ed Gambrell
What do health care personnel need to know about ostomy surgery? Communication is the key.
Now that you have an ostomy or an internal diversion, some changes have occurred in the normal routines of life. This is especially true of medical treatment and hospitalization.
Some medical and hospital assumptions and routines applicable to non-ostomates may no longer apply to you. For your comfort, well-being and in some instances, your health and personal safety, it is important that you know how you need to be treated differently. You need to communicate this information appropriately to doctors and medical attendants who need to know.
Your doctor, ostomy nurse and others who normally attend your ostomy are no doubt well-informed of the difference in treatment you require and will help you communicate with medical personnel uninformed about ostomy matters.
The fact that some health care personnel may be uninformed is quite understandable. The staffs of the thousands of hospitals in North America see relatively few ostomy patients. Few nurses and other hospital attendants have ever cared for an ostomy patient. And, many of those who have are not aware of the different types of ostomies and the special considerations each requires.
Doctors have become highly specialized to bring more expert care to patients. Therefore, many rarely have the occasion or the time to develop expertise in ostomy care, which is very much a specialty in itself.
So don’t be shy about communicating your condition and its special requirements to all who attend to you for non-ostomy ailments. This is for their benefit as well as your own. If strong insistence should fail to bring about understanding, you have the right to refuse any procedure you consider harmful to yourself.
Dr. Marshall Sparberg, author of the excellent book Ileostomy Care and a frequent writer on ileostomy matters, has this to say: “It is within the individual patient’s right to refuse any hospital procedure, and no amount of insistence from an uninformed individual should change this decision.”
Ostomies are different. One of the most serious misunderstandings is that all stomas represent colostomies, and that all colostomies are the same. This can be disastrous for the patient who has an ileostomy or urostomy. It can cause trouble for the person with a transverse colostomy when treated as a sigmoid colostomy. In addition, even those with the same type of ostomy require variations in care and treatment. Ostomies vary greatly in nature just as individuals vary.
With regard to irrigation and enemas: Those with urostomies should never be given an irrigation or enema through the stoma. An irrigation could cause serious kidney infection and damage.
Those with ileostomies should never be given an irrigation unless a doctor, ostomy nurse or other expert gives one to break up a blockage, or for other compelling reasons. An irrigation or enema of the small intestine may cause the ileostomate ill effects. However, a colostomate may require irrigations; this poses no danger if it is done properly.
A stoma is not an anus. Some medical attendants do not realize the difference between a stoma and an anus. They may treat a stoma
as roughly as they treat an anus. If an enema or irrigation with a catheter is involved, care must be taken to avoid bowel injury. Some catheters, though streamlined on the end, are stiff and should not be inserted into a stoma unless performed by a physician or ostomy nurse. A cone is much safer, easier to use and does a better job than a catheter.
PARASTOMAL HERNIAS
The British Hernia Center & GB News Review, Via: Loraine Co, OH
When a stoma is brought out to the surface of the abdomen it must pass through the muscles of the abdominal wall, thus a potential site of weakness is immediately created. In the ideal situation, the abdominal wall muscles form a snug fit around the stoma opening.
However, sometimes the muscles come away from the edges of the stoma thus creating a hernia-stoma where there is no muscle.
Factors that can contribute to causing a stoma hernia to occur include coughing, being over-weight or having developed an infection in the wound at the time the stoma was made.
The development of a stoma hernia is often a gradual phenomenon, with the area next to the stoma stretching and becoming weaker with the passage of time. This weakness, or gap, means that every time one strains, coughs, sneezes or stands up, the area of the abdomen next to the stoma bulges, or the whole stoma itself protrudes as it is pushed forward by the rest
of the abdominal contents behind it. As with all hernias the size will increase as time goes by. Stoma hernias are rarely painful, but are usually uncomfortable and can become extremely inconvenient.
They may make it difficult to attach a bag properly and sometimes their sheer size is an embarrassment as they can be seen beneath clothes. Although a rare complication, the intestine can sometimes become trapped or kinked within the hernia and become obstructed. Even more seriously, the intestine may then lose its blood supply, known as strangulation. This is very painful and requires emergency surgery to untwist the intestine and prevent the straightened part of the bowel from being irreversibly damaged.
Regardless of inconvenience or pain, hernias are defects in the abdominal wall and should not be ignored simply because they might not hurt. There are surgeons who advocate that small stoma hernias that are not causing any symptoms do not need any treatment. Furthermore, if they do not need treatment it should not be by operation in the first instance but by wearing a wide, firm colostomy/ileostomy belt.
This is probably true with small hernias, in people who are very elderly and infirm or people for whom anesthetic would be dangerous (serious heart or breathing problems, for example.) Operative repair of the stoma hernia may be given serious consideration to improve the quality of life, prevent progressive enlargement of the hernia with time and make it easier to manage the stoma.
A FRUIT’S HUE COLORS ITS NUTRITIONAL VALUE
Via: Niagara Frontier Ostomy Assoc.
The next time you walk down the produce aisle, let color be your guide; the more intense the pigment of a fruit or vegetable, the richer it is in health-promoting compounds. Blueberries, blackberries, and strawberries pack the highest nutritional wallop, says Dr. Luke Howard, professor of food science. They owe their vivid colors to generous portions of cancer-fighting pigments. As a bonus, blackberries and strawberries also contain vitamin C.
Deep green vegetables like spinach and broccoli also score high in the nutrition game, but even pale vegetables like onions contain pigments that protect against heart disease. They’ve also been shown to lower cholesterol and maintain a healthy immune system. Here again though, color counts: red and yellow onions have more nutrients than white ones. The same holds true for tomatoes; they get their scarlet color from lycopene, which may protect against prostate cancer, and the redder they are, the more lycopene they have.
DOES YOUR STOMA HURT?
Via: The Dayton OH Ostomy Chapter & Southern Maryland Counties
Quite often people say that their stoma hurts. This is a surprise since stomas do not have sensation. You could cut, burn, do anything to the stoma and you would not feel a thing. That’s hard to believe, but true
Stomas do not have receptors for pain.
Sometimes the lack of sensation can lead to problems. For example, an incorrectly fitting appliance may cut into the stoma, but no pain will be felt. A stoma can be badly damaged before the problem is noticed. For this reason, it is important not to wear your pouch for long periods of time, since it is good to see if the stoma is OK.
Actually, when people talk about stoma pain, they are usually talking about pain from the skin around the stoma. That skin, the peristomal skin, is full of nerve receptors that are sensitive to such things as heat, cold, chemicals and adhesives that can cause pain. It is the skin that is sensing the pain, not the stoma. If any unusual symptoms or irritations are noticed, do not hesitate to contact your doctor or ET nurse for an evaluation, and if necessary, a prescription for a specific treatment.
ASK THE ET?
This month’s questions from the GB News Review & Southern MD Counties
Question: Do you think it is a good idea to rinse out my colostomy bag when I empty it?
Answer: I usually teach my patients the proper procedure for rinsing your pouch when emptying it, but then leave it up to you if you want to continue to rinse or not. By proper procedure, I mean rinsing the pouch up to the level of the bottom of the stoma. I find sometimes people rinse the pouch too vigorously and cause the adhesive seal around the stoma to loosen from the inside of the pouch by introducing water at the seal. Some people feel more comfortable using an opaque colored pouch and not having to worry about rinsing it at all. Again, I think it is a personal preference with what you are most comfortable with. Many people get along just fine without ever rinsing the pouch.
Question? What causes warts to form on the edge of the stoma?
Answer: A poorly fitting appliance can cause nodules to form around the edge of the stoma They are benign and will do no harm. If they get in the way, they can be removed by cauterization.
Question: When a colostomate who wears a pouch gets a blockage from eating too much food, should a laxative such as prune juice be taken? Should heat be applied? Would it be a good idea to irrigate?
Answer: When a colostomate gets a blockage, in most cases it is due to constipation caused by eating constipating foods, lack of physical activity, or use of pain medication. It is quite OK for a colostomate to take a mild laxative. The use of prune juice is an excellent suggestion. Foods with fiber, like bran, make the stools less constipating. For a person who has not irrigated, the other methods should be tried first.
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