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PURPOSE: Individualize plan of care with realistic and attainable goals that will clearly demonstrate improve quality of life for patient.
CLINICAL PROBLEM: 73 year old male with history of bowel obstruction, colectomy, temporary ileostomy; develops abdominal adhesions, which led to surgery, and unfortunately to a small bowel fistula. Multiple operations were undertaken to try and repair fistula; this was unsuccessful and ultimately the patient was transferred to ourMedical Center .
Patient experienced profound life changes diminished to the “hospital scene”; is cachectic with inability to walk. Fistula LLQ lateral wall, 3 x 2.5 x 1cm, above skin level, effluent > 1200 ml/24 hours. Perifistula wound 14 x 12.5 x 1 cm.
CURRENT CLINIC APPROACH: Wound bed covered with petroleum dressing. Periwound skin protected with ostomy powder, ostomy cement, and skin barrier. Creases filled with ostomy paste strip. Effluent contained by fistula/wound pouch, and connected to bed side drainage. Accurate measurement of effluent achieved. Interdisciplinary team met weekly to discuss measurable and expected outcomes for medical treatment, stabilization, and QOL (fluid resuscitation, nutrition with TPN and enteral feeding, mobilization, and sepsis control). MSW for mental health issues, counseling, and coping strategies. WOC nurse collaborated with team members, to include wound care nurse at future rehab facility to educate/instruct placement of pouch system. Physical therapy weekly for endurance and mobility training.
OUTCOMES: Nutrition improved greatly, pouching system successful with five day wear-time, wound contracting; patient has empowerment and improved mobility, which is light years away from where he had been.
CONCLUSIONS: Patient did have successful enterocutaneous fistula repair. The interdisciplinary team collaborated to enhance each other’s contribution toward optimal care and QOL for this patient. This patient did achieve his Olympic Gold……HOME.
CLINICAL PROBLEM: 73 year old male with history of bowel obstruction, colectomy, temporary ileostomy; develops abdominal adhesions, which led to surgery, and unfortunately to a small bowel fistula. Multiple operations were undertaken to try and repair fistula; this was unsuccessful and ultimately the patient was transferred to our
Patient experienced profound life changes diminished to the “hospital scene”; is cachectic with inability to walk. Fistula LLQ lateral wall, 3 x 2.5 x 1cm, above skin level, effluent > 1200 ml/24 hours. Perifistula wound 14 x 12.5 x 1 cm.
CURRENT CLINIC APPROACH: Wound bed covered with petroleum dressing. Periwound skin protected with ostomy powder, ostomy cement, and skin barrier. Creases filled with ostomy paste strip. Effluent contained by fistula/wound pouch, and connected to bed side drainage. Accurate measurement of effluent achieved. Interdisciplinary team met weekly to discuss measurable and expected outcomes for medical treatment, stabilization, and QOL (fluid resuscitation, nutrition with TPN and enteral feeding, mobilization, and sepsis control). MSW for mental health issues, counseling, and coping strategies. WOC nurse collaborated with team members, to include wound care nurse at future rehab facility to educate/instruct placement of pouch system. Physical therapy weekly for endurance and mobility training.
OUTCOMES: Nutrition improved greatly, pouching system successful with five day wear-time, wound contracting; patient has empowerment and improved mobility, which is light years away from where he had been.
CONCLUSIONS: Patient did have successful enterocutaneous fistula repair. The interdisciplinary team collaborated to enhance each other’s contribution toward optimal care and QOL for this patient. This patient did achieve his Olympic Gold……HOME.