Bringing in Ostomy nurses for problems & a Hospice question....

Specialties Geriatric

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Specializes in NICU, Peds, Med-Surg.

Wondering, because we have a resident with a new colostomy, and two open wounds VERY close to it. It has become a nightmare! We pack the open wounds, then cover them with dressings that become saturated with the pure LIQUID (it's gone from the usual pasty brown to pure green liquid (i.e....bile) stool from his colostomy:no:. Not only that, we have tried different types of wafers and bags, but they STILL leak. One day, his wafer/ bag had to be changed FIVE times....

And, as you all know, GUESS WHAT is happening with all those changes? Red, raw skin that I KNOW is going to break down soon. I was doing some research and found that stoma POWDER would probably help him, and the stoma paste isn't helping at all....what has been YOUR experience?

The other thing that's killing me is that we only give ONE Lortab a half hour before dressing changes.....seriously? And we're packing TWO wounds that are both at least an inch-two inches deep? This poor man!!! By the way, he has terminal cancer with mets.....

His wife asked that ALL pain/ anxiety meds be d/c'd because she doesn't want him to "get addicted"....The PA had to CONVINCE her to let us give ONE Lortab before dressing changes. He is of SOUND MIND, by the way---why does the wife get to dictate what pain meds he gets???? :no: I was sooo upset and FURIOUS the other day when I "tortured" him with his dressing change/ wafer/ and bag change. I also noted that the P.A. wrote they are TRYING to convince the wife it's time for hospice.

Again, I struggle with feeling empathy and compassion for the spouses/ children that seem to be what I think is denial......I realllly try to put myself in their place and realize that no matter WHAT the doctors/ PA's/ we tell them, they still get SO focused on worrying that their loved one will get ADDICTED to pain meds, and they also refuse hospice because to them, that means giving up....

I guess my original question has ANOTHER part---how does YOUR facility handle it when there's NO hope, the person is in PAIN, the person is of SOUND MIND, yet, the family/spouse is making all the decisions. He has even TOLD his wife he is "TIRED AND READY TO GO".....I'm trying to understand how all of this works, and i get sooo many different answers from my D.O.N. and the other nurses.....I'd appreciate hearing what people here have to say.....Thanks in advance!

((HUGS))) to all of you, this can be such a sad, difficult job, but part of me still LOVES it...I just want to do what's RIGHT for these sweet people!!! :nailbiting:

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Specializes in LTC,Hospice/palliative care,acute care.

Can you consult a wound care center? A good wound care center can hook you up with an ostomy nurse.There are so many products available and once you find the right ones you'll hear the angels sing.... I've had the best luck using the cut to fit cut to fit products and if needed using paste or powder to create a level area for the seal. If he has alot of uneven areas paste works best,IMHO..There are lots of barriers out there to protect and heal the macerated areas but if you get that flange cut exactly right that will stop being a problem.If you can't get him to a wound care center can you get the supply catalogue from your purchaser and look at the range of available products? most companies will send you a few samples to try.

Document,document,document.I have seen nurses call the DOH in this type of situation. Our admin informs the family that WE are responsible for the resident and we will treat them for pain,anxiety,etc and their alternative is finding another facility or take them home.

Why hasn't the PA or physician ordered a hospice consult? Let them contact the family and meet with them-that is their area of expertise.The whole team can meet with the entire family and spend hours educating and supporting them-they may still refuse hospice but at least you'll all know you tried...

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Wife need more education. And you need to involve social services or a vulnerable adult agency in your area. Ask MD to talk to family too.

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Wife need more education. And you need to involve social services or a vulnerable adult agency in your area. Ask MD to talk to family too.

That's a possibility, but often you can "educate" families like this until you're blue in the face and... some people are just idiots, sadistic ones at that.

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Specializes in LTC,Hospice/palliative care,acute care.

True-I'm involved with a family now-mother is close to a hundred and not eating. And it's OUR FAULT. Here shoes are too tight and she won't eat or her hair was not set and she won't eat or the lights are too bright in the dining room and she won't eat. One stupid comment after the other and they refuse to accept that she's almost a hundred and fading away .I see this ending very badly for her and it'll break all of our hearts to see her carted off to the ER when she is circling the drain instead of lying comfortably in her bed with comfort meds. And the nursing home cat at her side.

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Specializes in peds palliative care and hospice.

My home health agency has a hospice outreach nurse, maybe its time to have a talk? What about the social worker? I agree the wound center sounds like a simply splended idea.

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Specializes in Rehab.

These cases are always difficult. There has already been some very good advice on how to deal with the family. As far as the patients skin breakdown we have had good luck when we have treated with a skin protectant wipe followed by the powder. Another thing to consider is whether yeast may be a problem due to the constant moisture. If so an anti fungal may be needed as well. Good luck and keep advocating for your patient.

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I dont think that it is legal for anyone to withhold needed medical care from a patient. not even family. he's beyond curative treatment, but he requires pain medication to keep him from suffering. I wouldnt let his wife call the shots on this, she's just holding things up.

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Cut the wafer for the ostomy as small as possible to try to keep off he dressing, if hats an issue. Try putting skin prep on the skin prior to placing he wafer on the skin.

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Oh and on the pain Med issue. If her defers to his wife's judgement then u have to. However if he is of sound mind then u have to follow what he wants. If he wants pain meds then he facility must follow his wishes. Sounds like she just doesn't understand his situation and the unlikeness of dependance. She may end up being asked to leave cuz patient care comes first. Sounds like maybe sum good education may be a good place to start.

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Specializes in LTC,Hospice/palliative care,acute care.

Bumping the thread-can we get an update?

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