A NEW Urostomy....POOR VISION , POOR Dexterity and MS

MS progression and a new ileovesicostomy for neurogenic bladder. 54 year old female who lives alone, is essentially wheelchair bound, has Poor vision and poor dexterity.  This was complicated by the seal-off of her catheterizable stoma, and in January 2010 she had an indwelling Foley catheter.

In March 2010, Her CT scan failed to demonstrate definitive patent catheterizable stoma . Among all the options It was highly recommended for self-catheterization. Which she was able to demonstrate in the clinic.   

Home visit march 9 2010,  patient advised home care nurse, “I am not going to do that, it would be totally self defeating, I cannot do it, cannot get into my bed 4 x  a day, cannot get into chair, cannot manipulate catheter with hands, I just cannot do it. I did not tell them at the drs office but I knew I could not do it.

In April she returned to the clinic for follow-up, She failed to perform self-catheterizations. She desires surgical intervention. 

discussion about treatment options. She chose an ileovesicostomy , had the surgery on 05/10/10. stayed at a facility until 6/12/10 home care started on 6/13/10.

Home care WOCN assisted in pouching choices and coping with a goal of a 1 piece easy to apply pouch and independence. There have been Multiple pouching problems from systems to self care and discouragement. WOCN Worked with patient to get appropriate pouching system and developed a self guided book to help patient perform her own pouching, using her likes and her determination to get the task done. She looks forward to getting the self guided book out and following the directions, even with her poor vision and dexterity she is choosing to be self motivated and pouch herself.

With many positive outcomes, homecare discharge should occur in November.