The effect of preoperative stoma site marking on quality of life in patients undergoing ostomy surgery

The purpose of this study was to determine if preoperative stoma site marking by a Wound, Ostomy, Continence (WOC) nurse affects patient quality of life. This study used a descriptive design with a convenience sample of 25 ostomy patients. Sixty-three surveys were mailed to study participants and the response rate was 40%. Ten subjects (40%) had their stoma site marked by a WOC nurse preoperatively and fifteen subjects did not. Eleven participants reported that their ostomy was permanent (44%), while fourteen of the participants (56%) state they had a temporary stoma. Thirteen of the subjects had elective ostomy surgery (52%) and twelve (48%) had an ostomy created under emergent conditions. Overall quality of life scores did not differ between the marked and unmarked subjects. However, subjects who did not have their stoma site marked preoperatively had greater problems with pouch leakage (p=.0055) than those who were marked preoperatively

Does Preoperative Ostomy Education Decrease Anxiety in the New Ostomy Patient?

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. New ostomy patients that are well prepared may be able to adapt to the new body image and are more successful in management following ostomy surgery. Problem: Psychologists and sociologists have identified a link between anxiety levels and memory. Anxiety can affect learning by interfering with the attention process of the brain. This interference can hinder the ability of ostomy patients to effectively listen, learn, and perform ostomy care for themselves which places an increased demand on family, caregivers, and home health nurses. Pre-surgical education may offer reduced anxiety levels in post-operative patients, which may provide an improved environment for learning. Methods: Participants considered for study inclusion were those scheduled for ostomy surgery. Patients in Group 1 were provided with pre-surgical ostomy education and routine pre-surgical education, whereas patients in Group 2 were provided with routine pre-operative education only. The Hospital Anxiety and Depression Scoring tool (HADS) was administered during the post- operative period. The surveys were administered by a certified wound, ostomy, continence nurse practitioner. Analysis of Variance (ANOVA) was used to compare changes in anxiety scores between the two groups. Results: Of the 30 participants in the study, 22 were male (73.3%) and 8 were female (26.7%). The mean age was 65.27 ± 9.97 for Group 1 and 61.87 ± 17.56 for group 2. This difference was not statistically significant (p\u3e0.05). Both groups had an equal number of males (n=11) and females (n=4). Group 1 consisted of 9 colostomy patients, 4 ileostomy patients, and 2 urostomy patients. Group 2 consisted of 10 colostomy patients, 4 ileostomy patients and 1 urostomy patient. Patients who had pre-surgical ostomy education had statistically significant lower post surgical anxiety scores than patients who had standard education (p\u3c0.001). Conclusions: The findings of this study suggest that offering pre-operative ostomy education in addition to routine pre-operative education, significantly lowers anxiety when compared with patients who do not receive the pre-operative ostomy education

Complications And Stoma Care Self-Efficacy Are Associated With Ostomy Adjustment In People With An Intestinal Or Urinary Ostomy

poster abstractMore than 120,000 new ostomies, or surgically created openings through the abdomen for bowel or urinary elimination, are created annually in North America. Up to 80% of patients with a new ostomy experience ostomy-related complications that can interfere with adjustment to living with an ostomy and diminish quality of life. The purpose of this study was to examine relationships among ostomy complications, stoma care self-efficacy, and ostomy adjustment in people living with an intestinal or urinary ostomy. Examining relationships is important to identify people at risk for poor adjustment and to allow for early intervention to improve outcomes for these patients. Data were collected from 202 participants by trained telephone interviewers. Eligible participants: 18 years of age or older, had ostomy surgery within the past 24 months, currently have an ostomy, and were able to speak English. The Ostomy Adjustment Inventory-23 was used to assess adjustment to living with an ostomy and the Stoma Self- Efficacy Scale measured confidence in caring for an ostomy. Univariate analyses were conducted using t-tests, ANOVA, and correlations using the Statistical Package for the Social Sciences. Higher ostomy adjustment scores were observed in participants with permanent versus temporary ostomies (p=.002). Compared to those who did not experience ostomy complications, participants who developed peristomal dermatitis (p=.005), parastomal hypergranulation (p=.003), stomal bleeding (p=.004), and stomal retraction (p=.015) had lower ostomy adjustment scores. Stoma care self-efficacy scores were significantly correlated with ostomy adjustment scores (r=0.534, p=.000). Ostomy complications that may be modifiable influence ostomy adjustment. Additional support and education to reduce complications and enhance stoma care self-efficacy are needed for people at risk for poor adjustment. Future research is needed to develop and test the effectiveness of interventions to enhance self-efficacy and ostomy adjustment

Low zinc status and absorption exist in infants with jejunostomies or ileostomies which persists after intestinal repair.

There is very little data regarding trace mineral nutrition in infants with small intestinal ostomies. Here we evaluated 14 infants with jejunal or ileal ostomies to measure their zinc absorption and retention and biochemical zinc and copper status. Zinc absorption was measured using a dual-tracer stable isotope technique at two different time points when possible. The first study was conducted when the subject was receiving maximal tolerated feeds enterally while the ostomy remained in place. A second study was performed as soon as feasible after full feeds were achieved after intestinal repair. We found biochemical evidence of deficiencies of both zinc and copper in infants with small intestinal ostomies at both time points. Fractional zinc absorption with an ostomy in place was 10.9% ± 5.3%. After reanastamosis, fractional zinc absorption was 9.4% ± 5.7%. Net zinc balance was negative prior to reanastamosis. In conclusion, our data demonstrate that infants with a jejunostomy or ileostomy are at high risk for zinc and copper deficiency before and after intestinal reanastamosis. Additional supplementation, especially of zinc, should be considered during this time period

Pediatric Kennedy Terminal Ulcer

Photograph of Fossett's circus loads, 2 AEC Matadors - KKN412 - and trailers, taken Forest site, 28 September 1959 whole side view

Factors Associated With Ostomy Adjustment In People Living With An Intestinal Or Urinary Ostomy

poster abstractMore than 120,000 new ostomies, or surgically created openings through the abdomen for bowel or urinary elimination, are created annually in North America. Up to 80% of patients with a new ostomy experience ostomy-related complications that can interfere with adjusting to living with an ostomy and diminish quality of life. Short hospital stays and fragmented follow-up care make it difficult for people with new ostomies to adjust and find the support and resources they need. Little is known about factors that influence positive adjustment to a new ostomy. The purpose of this study was to explore demographic factors that may be associated with adjustment to living with an ostomy. Potentially eligible participants who had ostomy surgery in the past 24 months were identified from lists generated by wound, ostomy, and continence nurses in 5 hospitals affiliated with a major health system in Indiana. Introductory study letters were mailed to potentially eligible participants. Trained research assistants telephoned participants who did not call the office to decline in order to assess eligibility, explain the study, and answer questions. Quantitative and qualitative data were collected via telephone interviews from 203 participants and entered directly into the RedCap database. The Ostomy Adjustment Inventory-23 was used to assess adjustment to living with an ostomy. Data were analyzed using correlations, t-tests, and analyses of variance using the Statistical Package for the Social Sciences. Results indicated that participants with higher incomes had significantly better adjustment scores than those with lower incomes (p<.000). No other demographic variables were associated with ostomy adjustment. People with lower incomes may be at risk for poor adjustment after ostomy surgery. Additional support and education may be needed to enhance ostomy adjustment for people at risk. Future research is needed to develop and test the effectiveness of interventions to support ostomy adjustment

Physiology and prevention of heel ulcers: The state of science

The prevalence of heel ulcers across settings is high and is increasing. Prevention of ulcers requires knowledge of their etiology and the scientific basis for preventive care. The interaction between external pressure and the heel vasculature is central to the prevention of heel ulcers. This article focuses on the prevention of heel pressure ulcers. The physiology of heel tissue perfusion, the effect of external pressure on heel perfusion, as well as what is known about strategies to reduce external pressure and approaches to improve heel skin blood flow will be discussed. It is only through understanding of the physiology of heel tissue perfusion and its relation to external pressure that effective preventive measures to reduce heel skin breakdown can be adapted in clinical practice

Exploring Resilience When Living with a Wound — An Integrative Literature Review

The psychological impact for patients with wounds can be significant, and adverse psychological effects frequently occur when there are permanent changes in the body’s structure or function. Evidence suggests that anxiety, depression and stress can adversely affect the wound healing process. An integrative review examined any paper that discussed any patient in any health care setting who had experienced a psychological impact from the experience of having a wound and the experience of being resilient in that context. Ninety nine papers were located in the initial search with twelve meeting the inclusion criteria and being reviewed. A review of the papers identified that improvement and maintenance of quality of life was perceived to be an important aspect of patient management, but none focused on resilience as a primary endpoint. Further research is required into the clinical benefits of resilient behaviours in patients living with a wound

Establishing a Hybrid Wound and Ostomy Continuing Education Program

Wound and ostomy nurses receive specialty training and certification to provide care in abdominal stomas, ostomies, wounds, fistulas, and pressure injuries. The eight existing nationwide programs in 2011 were inadequate to meet increasing patient population demands. We developed an innovative nondegree, postbaccalaureate continuing wound and ostomy education program using a hybrid design. The program integrated interactive online classes with intensive onsite classes and skills training. The program has been granted seven-year accreditation; student evaluations have been positive

Unbearable wearables

As wearable devices play an increasing role in the management of health and disease, adverse skin reactions to wearables have become more common. However, the management of allergic contact dermatitis is challenging and new treatment options more compatible with wearable devices are needed. In a 40-year-old woman with contact dermatitis to a continuous glucose monitoring device, topical clobetasol propionate 0.05% spray proved to be an effective treatment that was compatible with the application of adhesive wearables. This case demonstrates that spray formulations of topical steroids are a good option for the treatment of dermatitis under wearable devices such as continuous glucose monitors or ostomy appliance