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We used the umbilical site for temporary colostomy or ileostomy in 47 infants and children. Complications were frequent but were not specifically related to the site of the ostomy. The umbilical site is a convenient site for placement of appliances, and ultimately, after closure, the scar resembles a normal umbilicus and is cosmetically superior to that of an ostomy placed elsewhere.
Patients with ileal pouches and ostomies present with management issues that are challenging to the clinician. Endoscopy plays a significant role in diagnosing and guiding therapy in such patients. Unfortunately, there are very few prospective studies that evaluates endoscopy in these situations. Nevertheless, it is clear that endoscopy remains a powerful tool that is important for diagnosis and therapy of complications unique to these surgical procedures. It seems prudent to advocate endoscopic cancer surveillance for patients with pouches and ostomies; however, it remains to be seen whether these efforts will ultimately have an impact on long-term patient morbidity and mortality.
The pelvic pouch and the continent ostomy provide reservoirs for fecal contents and avoid the need for traditional pouches. Patients with ulcerative colitis or familial polyposis coli now have the option of undergoing one of these procedures rather than a traditional ostomy. This article describes both procedures and covers preoperative and postoperative management, with emphasis on coordinated management by the ET nurse and surgeon.
Ostomy patients have been identified as a chronic illness population frequently experiencing adjustment difficulties. The present study, based on the biopsychosocial model (Engel, 1977) of chronic illness, examined a range of post-surgical adjustment difficulties in a sample of 131 ostomy patients. The patient population reported experiencing a significant number of technical, emotional, social, marital/family, and sexual difficulties post-surgically. Technical difficulties were associated with impaired emotional, social, and marital/family functioning. Emotional difficulties were also associated with problematic social, marital/family adjustment, and impaired sexual functioning. Technical problems, emotional difficulties, and social problems were all associated with the patient's perception of having received inadequate preparatory information. Marital/family and sexual maladjustment, on the other hand, were associated with low levels of perceived social support. The results of this investigation are interpreted as supporting the biopsychosocial model of chronic illness, and the clinical implications of these findings are discussed as well as their relation to previous research on adjustment to stressful medical procedures.
Colostomies are sometimes used to manage those SCI patients who have large pressure sores that are frequently soiled by stool. Seventeen such patients in an Acute Spinal Cord Injury Unit were reviewed to define the problem of ostomy prolapse in paraplegic patients. It was concluded that prolapse is more likely in those patients with an injury at or above the T-10 level. The two patients who had loop colostomies developed prolapse. Those ostomies that were end-sigmoid and exteriorized into an area where there was sensation and abdominal wall muscular integrity were the most successful.
Necrotizing Enterocolitis, a disease that affects the gastrointestinal tract of some premature neonates, often results in a temporary stoma. The fragile skin of these neonates, the small surface area of their abdomens, and the limited ostomy supplies available in appropriate sizes can cause difficult pouching situations. The use of a flexible skin barrier with the smallest available pouch maintains the principles of ostomy care, protecting the skin and containing the effluent.
Two patients with contact dermatitis from an ostomy agent are described. Detailed patch testing revealed contact allergic dermatitis to one of the twelve groups of ingredients which largely comprised citronella oil. The problem of dermatitis is discussed in relation to the perfume ingredients of the ostomy agent.
We present the psychosomatic aspects in self-help groups containing medical patients on the examples of the ostomy group. Following the demonstration of the psychodynamic group processes, the patients' psychological characteristics are described as well as the aims of this type of self-help group. The specific ostomy group activities concern the visitors' service and the group work. Finally, we describe the psychotherapeutic interventions of the psychosomaticist.
The purpose of this article is to analyze the nonverbal communication of the participants in a group of bowel cancer ostomy bearers. The type of the investigation was exploratory and observational. The investigation was carried out in a Teaching Hospital. The population was composed by 5 persons, bearing ostomy due to bowel cancer. There were 5 meetings in October and November of 2001. Data was gathered through video recording and field notes. Among the findings we remark the room small size forced the participants to maintain a very close distance that led in difficulties for their spontaneous expression. This article clarifies that the reading of the nonverbal communication enabled the understanding the universe of the investigated persons.
This study aimed to analyze and compare the quality of life of patients with colorectal cancer who were attended by the Single Health System in Sao Paulo. A descriptive and transversal study was carried out from a quantitative approach. Data were collected through the World Health Organization Quality of Life-bref scale (WHOQOL-bref). 110 patients were observed, resulting in a population of 48 patients, who were divided into 2 groups: with and without ostomy. No differences in the average scores for the four domains were found between the groups. Statistical differences were found in the variables of religion and return to work independent from the group. This study was important to get a better understanding of quality of life in cancer patients with and without ostomy.
This study aimed to analyze the frequency of efficient and inefficient behavior in members of a group of ostomy patients due to bowel cancer. An exploratory and observational field study took place at a public service hospital in São Paulo, Brazil. The population consisted of 5 persons who joined in a group. After approval by the institutional Ethics Committee, 5 meetings were held in October and November 2001, guided by the following themes "me before getting ill", "me ill and the treatment", "me recovering with an ostomy", "me and daily life", "me in this group". Data were collected through videotaping of the meetings and field diary records, and were subject to quantitative analysis by means of tables and graphs, on the basis of an established model. The preponderance of rigidity and competitiveness in the intragroup relationships was explicit and determined stagnation and stereotyped attitudes in interaction.
Twenty-six patients showing peritonitis due to nontraumatic acute abdomen were submitted to ostomy. Mean age was 51 years (range 25-83), being 13 males and 13 females. Bowel obstruction (BO) was the most frequent cause of peritonitis (11 cases), followed by intestinal perforation (IP) (8 cases), acute mesenteric infarction (AMI) (5 cases), and acute abdomen of inflammatory/infectious origin (AAIO) (2 cases). Brook's ileostomy was performed on 65% of the patients. Jejunostomy was performed only in 4 patients, leading to a bad evolution. Overall mortality was 54%. Primary ostomy or anastomosis in cases of peritonitis constitute a highly controversial theme. Indications and problems involving the intestinal exteriorization in emergency surgery urgency are herein discussed.
Total exenterations require fecal and urinary diversions, necessitating ostomies in the anterior abdominal wall. This article was done to explore the possibility of extremely low anastomoses of the intestine to the anal stump, to reduce the number of ostomies to only one for the urinary diversion. Although technically feasible, the long term follow-up evaluation of these patients resulted in us having reservations concerning function.
The Data base is a tool for use by experienced and new ET nurses to document information gleaned during the initial contact with a new patient with an ostomy. The Data base may be used to structure the interview or simply to record the data. The summary section at the bottom of the form facilitates prioritization and listing of goals for care of the patient. The Data base documents data used by the ET nurse as she formulates her plan of care for the patient with an ostomy. By demonstrating the scope of the assessment and organizing its content, the Data base is one way of ensuring comprehensive data collection, an issue paramount to quality care.
Ostomy surgery is performed in patients of all ages from the infant to the elderly, bed-ridden patient. The total patient, not just the ostomy, should be the focus of the nursing care plan. Each age group of patient has its own special characteristics, although there are commonalities. The unique needs of infants, young children, adolescents, and geriatric patients are presented.
INTRODUCTION: This study looks at the degree of satisfaction colostomy patients feel in regards to their perception of the health care that they receive, whether they think that their physicians care could improve and the level of the medical staffs professional experience. METHOD AND MATERIAL: The study was performed in the Area Hospitalaria de Valme (Sevilla). With a population of 350,000 possible patients of which 215 have an ostomy, 55 of these took part in the study. 215 questionnaires were mailed to the ostomy patients with paid return mail enclosed. The survey was based on Lickerts attitude scale and had six items to respond to, using an evaluation of zero to five. This method is sufficiently valid and has been used in other studies such as project CORCH. RESULTS: First, averages were obtained for all items and variables. Second, a patient profile was obtained regarding sex and age. Third, a correlation of the three study variables was compared against variables of a global index of satisfaction. DISCUSSION: In contrast with the global index, the satisfaction of the patients in the study is very high (3.93 out of a possible 5). 45% of these patients perceive that the medical treatment that they receive could improve but that the professional experience of the medical staff is acceptable (62%).
Advanced pelvic surgery may result in the formation of a colostomy, ileostomy, urostomy, or multiples of these stomas. Stomas may be created because of a planned therapeutic attack to eradicate cancer or manage complications arising from treatments or they may be constructed to palliate severe symptoms or life-threatening problems. In some instances, fistulae between various organs and the skin may occur. Special skills are required to meet the needs of patients with ostomies or fistulae. The often complex care presents critical challenges to nurses, particularly in today's cost-conscious health care environment where prompt hospital discharges, brief clinic appointments, and valuable but limited home care visits are the norm. The skills of the enterostomal therapy nurse are valuable in all phases of care of these patients, from preoperative to outpatient care.
Culture is an inextricable part of the fabric that defines each human as an individual, a family member, and a member of local, national, and global communities. This article describes a nursing theory that supports the significance of culture as an essential concept of nursing practice. To illustrate the applicability of these concepts to WOC nursing practice, a case study of a Mexican-American client with an ostomy is presented.