Lessons 35-36: Rehab For The Ostomy Patient Flashcards
Potential Impacts on Quality of Life
- Alterations in body function and appearance
- Loss of sphincter + modified continence
- Initial adjustment is major challenge
- Trauma causes increased anxiety +/- period of emotional numbness
Factors Impacting Coping Skills
- Preoperative personality and coping skills
- reason for surgery
- patient expectations about impact of stoma
- response of family and friends
- cultural issues
- development stage of patient
- what help is available to the patient
- access to an ostomy visitor/peer support
Questions to ask preop
- What are your biggest concerns about having an ostomy
- Have you been able to talk about the ostomy with you significant other?
- How do they feel about it?
- Are you concerned about the potential impact on your relationship?
- What do you think you’ll be doing in 3-6 months?
Questions to ask postop
- How are you doing/feeling?
- Who is emptying/changing the pouch?
- What problems are you having related to the ostomy?
- How are you doing in returning to your usual activities?
- Are you in touch with any support groups?
- How can I help you?
Indications of Self-Mastery
- Pouch management
- Pouch change procedure
- Management of peristomal skin breakdown
- When and how to obtain supplies
- Community resources
- Prevent and management of complications
Adaptation Process
1) Shock, panic, disbelief
2) Denial
3) Acknowledgement, anger, and depression
4) Adaptation + resolution
Adaption Process - Shock, Panic, and Disbelief
- Response to news that threatens sense of security
- Hysterical or mechanical behavior
- Best intervention is supportive care
Adaptation Process - Denial
- Manages the threat by denying/minimizing its existence
- “Morphine for the soul”
- Preop
— Patient believe they won’t need the stoma - Postop
— May ignore stoma
— Refuse to look/refuse self-care
— Focused on ostomy takedown/reversal - Interventions
— Avoid direct challenge
— Focus on informed consent
— Use gentle confrontation to help direct focus on discharge
Adaptation Process - Acknowledgement, anger, and depression
- Patient begins to actively deal with their feelings
- Common behaviors
— Anger (irritability, hostility)
— Sadness (withdrawn, crying, negative statements)
— Acting out (wearing pouch outside clothing) - Interventions
— Supportive listening
— Reassure negative feelings subside over 3-6 months
— Encourage patient to grieve openly
— Gentle confrontation for “acting out”
Adaptation Process - Adaptation + resolution
- Acute grief subsides
- Focus shifts to mastery of self-care and moving forward
- Patient asks lots of questions
Interventions
- Teaching
- Problem solving
- Basic counseling
- Referral to support groups
Primary Concerns for Ostomy Patient
- Self care
- Pouch leakage/odor/noise/embarrassment
- Clothing issues
- Dating + sexual concerns
- Sports/travel/leisure
- Body image/ “feeling dirty”
- Cost of supplies
Role of the Ostomy Nurse
- Gently encourage and push patient
- Establishment of secure pouching system
- Ongoing assessment of progress in adaption
- Education in self care and ostomy management
- Supportive counseling/support group referral
Principles/Guidelines for Effective Education
- assess the patient’s readiness to learn
- Delay Teaching when patient is upset or in physical distress
- Focus initial teaching on survival skills
- Avoid information overload
- Keep instructions as simple as possible
- Plan for repetition
- Use of multiple teaching and learning strategies
- Use demo + return to teach skills
- Constantly evaluate patient’s learning
- Assure home health and outpatient followup
- Select appropriate teaching materials
— 5th grade reading leave
— 14pt font
— Simple layout
Teaching Based on Developmental Stage - Infants
- Teach parents with above guidelines
- Suggest clothing modifications to maintain pouch seal
- Provide support to parents in baby’s health adaptations
Teaching Based on Developmental Stage - Toddlers/Preschool
- Pouching modifications to address increasing activity levels
- Play therapy
- School age children should begin participating in care
Teaching Based on Developmental Stage - Geriatrics
- Shorter, more frequent sessions
- Written materials in large, dark font
- Simplify procedures and instructions
- Product considerations
— Consider dexterity and hand/eye coordination issues
— Cost issues
Supportive Counselling
- Ask patient how ostomy is impacting their life with specific problems
- Listen to the patient - focus on truly hearing them
- Acknowledge patient’s physical and emotional pain
- Provide honest feedback and help patient maintain perspective
- Discuss normal emotional response and usual time frame for feeling better
Depression
Indicators
- Frequent crying
- Consistent withdrawal
- Negativity
- Loss of appetite
- Sleep disturbances
- Inability to concentrate
Need to screen
- Have you felt down or depressed over the last 2 weeks?
- Have you felt pleasure in doing things over the last 2 weeks?
- Screening tools
— Beck Depression Inventory
— Geriatric Depression Scale
- Suicidal thoughts?
Mild depression
- Acknowledge feelings of sadness are normal
- Encourage to discuss feelings openly
- Encourage to set goals + focus on accomplishments
- Encourage to challenge negative thoughts
- Assist to maintain perspective
Anxiety
Indicators
- Excessive worry
- Preoccupation with ostomy
Assessment
- Gentle confirmation and open discussion
- Differentiate between normal nervousness and severe anxiety
— Does it preclude participation in activities?
Severe anxiety
- Preventing patient from progressing/participating in usual activities
- Referral to psych for medications and therapy
Frustration
Irritability and anger over small problems
Interventions
- Encourage patient to identify what is frustrating
- Acknowledge this is difficult and frustrating time
— Trying to master a new skill while not feeling well isn’t easy
- Encourage patient to vent feelings honestly
Ask: “Is there anything I can do to make things better?”
