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Now before you leave the room again make sure
that patient's in a comfortable position and lower
that bed to its lowest level for safety, don't
forget those side rails make sure those are up,
dispose of any of the use supplies and especially
that old ostomy. Now we can remove our gloves,
perform our hand hygiene and we can document
our procedure. So when we're talking about
documentation for an ostomy, there's five key
points we want to talk about so first, what kind
of ostomy is it. So here's a great example if you
follow along with me on this image, so at 1100
there's a two-piece hollister ostomy appliance
with two and a fourth flange and pouch changed,
now we want to talk about that stoma color if you
remember, what's a bad stoma color? Remember
that necrosis we want to make sure this appears
normal so here's a great documentation piece for
that. Stoma color appears normal without signs
of erythema or dermatitis and again remember
that skin integrity with care, the skin integrity
is intact with no signs of ulcerations or lesions
and again think about that stoma remember
that assessment of that is key so see here
how they've documented the texture of the stoma
is moist. Okay so let's pause here for a minute,
so you hear that you hear that they're saying
the stoma is moist that should be the case with
your stoma, anytime you're assessing it I want to
bring that home again that it should be red,
reddish pink, pinkish and moist and
that's normal and that's what we want to see
and lastly, don't forget about skin turner,
we should have normal soft skin sugar here. So
we've talked about a lot of things in regards
to the ostomy but I have a few more takeaway
points for you in regards to that so let's look
at some special considerations, so let's take a
look at this slide you see there's six things
to think about so we talked about maintenance
of it but what about the patient itself so
let's really dive into a couple of these.
So let's talk about odors first, so this is a
really big topic for a patient as you can imagine.
A patient can have an ostomy for a while so if
the patient's out and about their day really
having an odor, that may affect them or someone else
could smell, could be really embarrassing for the
patient, so again we talked about earlier there's
some appliances that have these great filters on
it to allow that digestive gas to be released so
that ballooning doesn't occur without odor so this
is really helpful for the patient. Now if they do
have a filter, we want to. prevent that filter from
getting wet so instruct the patient if they shower
they may want to just put a piece of medical tape
for example over that to keep that from being
damaged. Now when we're talking about bloating,
this can be really uncomfortable for a client so
it's a great idea to talk about some dietary tips
for them so encourage that patient to keep
a food diary so anytime they eat something
they may notice okay well this is going to make
me feel really bloated, there's a lot of gas
which foods are those, so it's important for the
patient to be able to identify this themselves.
Now which food? Now if you guys remember
beans is one, that's definitely going to cost
some gas for your patients, fruits, some veggies
for example really dairy can do it as well
especially grains, nuts and also those really
bubbly carbonated beverages and lastly, it's a
good idea to teach your patient to eat slowly in
order to swallow less air, you may think what are
you talking about? So here's a great example,
like if a patient goes through a straw they're
gulping a lot of air and as you know that can
help increase the amount of gas maybe that they
feel and also contribute to bloating, also have
them slow, too slowly, so their brain will trigger
when they're full. Now here's a couple of tips
like we were talking about so we don't absorb too
much extra air or swallow too much extra air like
drinking through a straw like we just talked about
also chewing gum is another one, now don't forget
smoking, so we know as nurses this contributes to
a lot of issues but it will also contribute to
bloating and gas for your patient and again this
one may be a hard one for your patient but trying
to reduce the amount of carbonated beverages
so we all like our certain colas for sure but this
can definitely contribute to gas for your patient.
Now let's take a moment and pause on body image,
this is something as a nurse we get in a hurry,
we may not really think about this but
if you guys remember there were so many
new ostomies each year that occur for
patients this is definitely going to affect
someone's feeling of their body image and this
is important for us as nurses to be aware of,
so here's a couple of things for them to consider,
the good thing about an ostomy a lot of the time,
a lot of the times they can actually
wear this under their regular clothing,
however, there's some great things out there
like some special underwear that comes up high,
there's also wraps for example to where when the
patient puts on their clothing, you can't even
tell it's there so just be aware of this that body
image really is something that we need to be aware
of that this could affect our patient emotionally
and psychologically. And next, when we're talking
about body image, as a human sexual relationship
and intimacy is part of that, if you remember that
Maslow's hierarchy of needs, it's a basic need of
a patient and this can be resumed with an ostomy,
but this is important as the nurse to have an open
dialogue with your patient here and lastly, living
with an ostomy. Let's talk about just about three
things that are important to wrap this up about
things they need to consider, so having extra
supplies on hand at all times, you may think okay
really? You just never know though sometimes
maybe the bag, the bag may peel off, maybe you
lose the clamp so it's really important for the
patient and teach them to be prepared at all times
and we've touched on this but encourage
independents with individual ostomy care.
I'll tell you a lot of the times I've had
patients in the hospital that I've taken
care of and they really did all of their care for
the most part because they just knew their body
and were able to take care of this themselves
and it really helps promote independence
and again as nurses we should allow this and
lastly, don't forget about support groups,
again living with an ostomy, this may be
temporary, it may be longer term we also
talked about sexual intimacy and body image
earlier. This can be something that's a big
life-changing event for a client so make sure you
refer them to those as well. Thanks for watching.