OneSizeDoesNotFitAll

One Size Does Not Fit All

Connie Johnson, BSN, RN, WCC, LLE, OMS

Purpose:  To raise awareness that a stoma is not always as pretty as a rose bud; this may make effluent difficult to manage.  Ostomy nurses need to be readily available, possess knowledge, compassion and supplies.

Method:  Patient #1--32 yo hx ulcerative colitis, loop ileostomy shown, had temporary colostomy in past.  Able to manage independently.  Patient #2--42 yo female, recent bowel resection secondary to cancer; 4 weeks post-op bowel obstruction extensive adhesions; temporary ileostomy, mucocutaneous separation from 11-3 secondary to fistula behind stoma; reversed at 5 weeks post-op due to difficulty managing appliance.   #3—54 yo female, permanent colostomy secondary to extensive history of Crohn's disease; difficult to find appropriate appliance, patient was custom molded, manages well on own.  #4--84 yo female, ileostomy secondary to obstruction; patient did not remain stable in surgery, surgeon was rushed to get patient off table; retracted stoma LLQ, 10 days of trial and error, convex precut with good results patient was transferred to sub-acute rehab and returned 8 days later as they ran out of barriers and could not get a good fit with what they had on hand. Peristomal excoriation secondary to effluent on abdomen persisted.

Result:  Each patient in each case is so different that management of effluent, peristomal skin and emotions need to be addressed individually.  Any surgery can be debilitating; ostomy surgery is a major life changing surgery.  In an emergent situation it is not possible to appropriately mark patients so appliance fitting may be difficult.

Conclusion:   In ideal world post-op ostomy patients should be fitted for appliance and sent on their way to manage their major life changing event successfully.  In reality, as an ostomy nurse, you become part of the patient’s family.