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Colostomy
Surgical formation of an artificial anus by connecting the colon to an opening in the abdominal wall.
A Look at the Purpose and Outcomes of Colostomy Irrigation
Below are some criteria to consider during this assessment.3 Candidates should have: * a descending or sigmoid colostomy * a history of regular bowel habits prior to surgery * the desire to learn and perform the procedure * the ability (manual dexterity and visual acuity) to perform the procedure &...
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Correlating the Fecal Incontinence Quality-of-Life Score and the SF-36 to a Proposed Ostomy Function Index in Patients with a Stoma
Quality of life is affected by the creation of a stoma. To assess the validity of the Ostomy Function Index in patients with a stoma, a prospective survey was conducted from July 2000 to September 2001 among patients participating in local United Ostomy Association chapters (N = 99; 55 with a colostomy and 44 with an ileostomy). The Short Form 36 general health survey, Fecal Incontinence Quality of Life Scale, and the proposed Cleveland Clinic Florida Ostomy Function Index were used to assess general health and stoma function in patients with an ostomy. The average proposed function index score (7 = excellent function, 35 = poor function) was 11.97 (range 7 to 22). The proposed function Index correlated with the Fecal Incontinence Quality of Life Scale and the physical and mental component scales of the SF-36 (P <0.05). The correlation between the proposed function index and the Fecal Incontinence Quality of Life Scale was stronger in colostomy than in ileostomy patients. With the exception of the SF-36 role-emotional domain in ileostomy patients, the function index correlated with all SF-36 scales (P <0.05) in both patient groups. The results of this study suggest that ostomy function is variable and correlates with quality of life and that the Fecal Incontinence Quality of Life Scale offers a limited assessment of quality of life in colostomy patients. The Cleveland Clinic Florida Ostomy Function Index offers an objective assessment of ostomy function that reflects on quality of life. Additional studies to refine measurement of quality of life in stoma patients are warranted. KEYWORDS: fecal incontinence, ileostomy, colostomy; quality of life, ostomy
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Managing Oversight of Colostomy Irrigation in Long Term-Care
Postoperative colostomy patients are frequently referred to skilled nursing facilities for instruction on colostomy irrigation and ostomy self-care. Because nursing home residents are often elderly, fragile, bedbound, malnourished, and have multiple health problems, they are particularly vulnerable to dehydration and constipation. A practical solution would be to ...
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Alleviating Debilitating, Chronic Constipation with Colostomy after Appendicostomy: A Case Study
Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances. KEYWORDS: constipation, sigmoidocele, appendicostomy, colostomy
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Preparing the Patient for Colostomy Care: A Lesson Well Learned
Measuring the Stoma and Applying the Correct Wafer Size To prevent skin problems and stool leakage from the pouch system, the wafer must fit properly onto the peristomal skin. The cut-to-fit wafer needs to be cut to the correct size before use. Another wafer option is the convex style.
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Randomized Crossover Comparison of Adhesively Coupled Colostomy Pouching Systems
Ostomy pouching systems affect well being and quality of life, making selection of the appropriate system a key element of ostomy care. Several innovative adhesively coupled, two-piece systems are on the market. They feature flexible low profiles, allowing pouch removal/replacement without changing the skin barrier or wafer. This facilitates inspection or pouch changes without disrupting peristomal skin. Because few controlled trials compare pouching system effectiveness, a prospective, randomized open-label, crossover study was conducted. Under the supervision of ostomy care nurses in six outpatient clinics in Germany, clinical performance of and patient preferences for two adhesively coupled, closed-end pouching systems were compared during normal use. One is a gelatin/pectin-based skin barrier sealed to the pouch with a company-specific adhesive coupling technology (System E); the other, a grooved base plate wafer adhesive pouch coupling system (System F). Seventeen attributes and seven end-of-study measures that included comfort, flexibility, wear time, ease of removal, and overall performance were assessed. Informed, consenting participants were randomly assigned to use one system for five skin barrier/wafer changes or up to 15 days and subsequently switched to the alternative system for a similar period. The 39 participants used a total of 1,645 pouches and 342 skin barriers. All were found safe as determined by incidence and nature of the reported peristomal skin problems, subject withdrawals, and adverse events for both systems. However, System E provided longer pouch wear times (P < 0.01). End-phase ratings favored System E on 10 of the 17 attributes (P <0.04) and System F on none. More participants preferred System E on all seven end-of-study measures, five significantly (comfort, flexibility, wear time, ease of removal, and overall performance; (P <0.02). These participant-reported, ostomy-related outcomes underscore the importance of product evaluation and selection for persons with an ostomy.
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Part 1: Assessment and Management of Stomal Complications: A Framework for Clinical Decision Making
Assessment and management of stoma complications are often the responsibility of nurses across the continuum of care. These complications can occur at different times based on their etiology ? immediately postoperatively or even several years after surgery ? and often require modifications in a person?s daily stoma management. This article presents a conceptual framework to help categorize types of stoma complications based on either etiology or location and offers management options to facilitate quality care. The five major categories of complications include Poor Siting, Stoma Proper, Peri-Intestinal Area, Mucocutaneous Junction, and Iatrogenic. Most of these suggested approaches to care are the recommendations of certified ostomy nurses based on their educational training, expert opinion, and successful experiences. Although these recommendations have often solved the specific problems and greatly improved the quality of life for the person with stomal complications, much research is still needed to confirm and/or improve these nursing approaches. KEYWORDS: stoma complications, stoma assessment, stoma management, pouching techniques, pouching modifications
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Challenges of Ostomy Care and Obesity
In the United States, 13 to 16 million people are morbidly obese to the extent that medical intervention, simply based on obesity-related comorbidities, is needed. The challenge of ostomy care and the very obese patient lies in the skill and planning required for successful physical, emotional, and spiritual recovery. It is commonly believed that from the onset, the obese patient having surgery is at a significant disadvantage. Care of the obese patient requiring ostomy surgery includes considerable challenges - from preoperative preparation, including finding an optimal location for stoma placement, to the challenge of preventing complications during the intraoperative and postoperative phases of care. Concerns regarding pain management, immobility, skin injury, respiratory issues, embolic threats, and caregiver injury increase when treating the obese patient and must be addressed specifically. A case study approach is used as a framework to discuss the ostomy experience. KEYWORDS: obesity, bariatric, ostomy, colostomy, surgery
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Ostomy Statistics: The $64,000 Question
Number of Patients Currently available estimates of the number of patients vary. Gender No definitive gender data are currently available for the ostomy population. The Challenge Remains This aspect of ostomy care and management deserves an investment of research dollars.
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Clinical Experiences with Technologies: Case Reports on the Use of Two Hydrofiber(R) Dressings
Moist Wound Healing Modern wound dressings seek to counter the enemy of wound healing - desiccation. Two types of modern dressings have been increasingly used in wound management: hydrocolloid-based and alginate-based dressings. The dressing was left in place for 7 days, during which time the outer dressings were changed without disturbing the core wound dressing.
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