Living Well With an Ostomy. Maggie Bork, RN, BSN, CWOCN

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1 Living Well With an Ostomy Maggie Bork, RN, BSN, CWOCN

2 Objectives 1. Describe the 3 most common types of ostomies. 2. Discuss the results of recent research studies related to peristomal and stoma challenges. 2. List 2 contributing factors to successful transitioning from hospital to home life.

3 FACULTY DISCLOSURE I am an employee of Coloplast

4 What to do with this ostomy.

5 Anatomy & Physiology of the Gastrointestinal System

6 Introduction Stoma Greek = mouth or opening Cutaneous Stoma = opening to the skin or surface of the body Ostomy A surgically-made opening in the body, named for the organ in which the opening was made

7 Stoma Types End Stoma

8 Stoma Types Loop Stoma

9 Stoma Types Double Barrel Two stomas separated by a bridge of skin Proximal (functioning) Distal (non-functional mucous fistula)

10 Stoma Assessment Location Viability Peristomal skin Mucocutaneous junction Size Output

11 Stoma Characteristics Pale to deep pink Should drain from center of or slightly off-center May bleed slightly Move with peristalsis and evacuation Are insensate

12 Changing the Pouching System Change twice a week Change if burning or itching

13 Ostomy Management Ileostomy & Colostomy

14 Ileostomy - Characteristics Right side of abdomen Protrudes / 2 Diameter 1 High levels of fluid loss and possible electrolyte imbalance

15 Ileostomy - Output Initial output 1000cc-1800cc/day Typical output 500cc- 800cc/day Drink glasses of fluid If diarrhea occurs - empty pouch, drink a glass of fluid

16 Ileostomy - Medications Do not take enteric-coated or time-released medications Do not crush or open medications Inform pharmacist Never take a laxative

17 Colostomy Types / Output Cecostomy Transverse colostomy Descending colostomy Sigmoid colostomy

18 Colostomy - Characteristics Output dependent on location in colon Diameter 1 1 / 2-2 Protrudes 1 / 2-3 / 4 Gas and odor Constipation

19 Ostomy Management Urostomy

20 Urostomy Anatomy & Physiology Kidneys Filter waste product from blood, create urine Ureters Transport urine to bladder Bladder Stores urine Urethra Transports urine out of the body

21 Urostomy - Types Permanent Diversion Ileal Conduit Segment of ileum

22 Urostomy - Post-Op Stents Anti-reflux urostomy pouch

23 The DialogueStudy: a wealth of real-life experience 72% of subjects had a peristomal skin disorder upon enrollment. 1% 9% 3% 6% 19% 10% 45% Peristomal skin condition Irritant contact dermatitis Allergic contact dermatitis Mechanical trauma Disease related Infection related Other >1 reason Missing 7% Only 29% of subjects considered themselves to have a peristomal skin disorder upon enrollment.

24 Irritant Contact Dermatitis

25 Market research study confirmed leakage is still a top issue for people with an ostomy Skin problems (irritation) Leakage: sudden/slow Size of stoma Stoma changes Hernia Ease of use Problems applying/changing Acceptance/getting back to life Psyche of the patients Visibility Smell (actual or perceived) Ballooning Noise from bag (crinkles) Other 14% 9% 6% 15% 5% 7% 3% 12% 11% 6% 4% 15% 61% 61% 0% 20% 40% 60% 80% % of nurses Q: Once end users are discharged, what are the top three main stoma issues for the end user within the first six months after discharge? Source: Coloplast IMS study, July 2010, N = 500

26 After ostomy surgery, people experience a number of body challenges that contribute to leakage issues 42% Creases and folds More than 80% 29% Limited scarring, creases and/or folds 23% Deep of people scarring with an ostomy have challenges 20% Hernias 11% Irregularities & issues near the stoma Source: IMS study, 2010, N = 1700

27 People need to feel like they can live the life they want to live after ostomy surgery ~50% ~50% ~70% of people with an ostomy feel they can t live the life they want to live feel their ostomy pouch is too visible and they need to hide the fact they have an ostomy feel like they stand out because of their ostomy Source: Coloplast survey in US, UK, DE and FR. July Total respondents: 707

28 Support patients throughout their journey Pre-surgery Post-surgery Life Contributing factors to a successful transition

29 Conclusion Assess History Prevent Eliminate the cause Education & provide support

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