rectovaginal fistula

leslie :-D · Aug 13, 2004

where did they have the catheter....in her lady parts???

it sounds like she's late in her disease process....is she alert?

is she eating or drinking?

what are her chief complaints?

make sure she gets gentle but thorough pericare....

if the fistula is visible on the epidermis, keep it clean and covered.

monitor for shutting down of gu, gi systems.

keep her comfortable with meds for pain, anxiety and nausea;

prevent constipation.

are you a hospice nurse? sounds like she needs a definitive plan of care.

leslie

leslie :-D · Aug 13, 2004

i also wanted to add, that in addition to dark towels, perhaps tampons or sanitary pads may be helpful.

open windows to eliminate any odors. sprays may be nauseating for patient, but do try to eliminate offensive odors.

the patient is at high risk for an alteration in self perception, so keep draining areas as clean as possible, as well as out of sight.

if there is infection, treat it to extent feasible.

and of course, make sure she feels clean....bed bath, hair brushed, mouth care, clean bedclothes.... this poor lady.

leslie

saribeth · Aug 13, 2004

i also wanted to add, that in addition to dark towels, perhaps tampons or sanitary pads may be helpful.
open windows to eliminate any odors. sprays may be nauseating for patient, but do try to eliminate offensive odors.
the patient is at high risk for an alteration in self perception, so keep draining areas as clean as possible, as well as out of sight.
if there is infection, treat it to extent feasible.
and of course, make sure she feels clean....bed bath, hair brushed, mouth care, clean bedclothes.... this poor lady.
leslie

Yes I am a hospice nurse...and we are keeping her pristine clean and her purple nail polish and lipstick are lovely! We have the "dynamic duo" Roxanol and Lorazepam in place and she is also on 50 mcg of duragesic. Most days she is alert and oriented but does sleep a lot thank goodness...with the former pt the foley was inserted in her lady parts but they did the procedure in the hospital and the doc said under nooooooooo circumstances are we to change it! With this pt it is very difficult to see exactly where the fisutla is because when it rains it pours! I will have to see if the tampons would work that is a good thought. She is a delightful person and is so ready to go, but alas as per usual it is not happening. Thanks so much for your input

hospicenurse · Aug 13, 2004

I would be very leery of inserting a tampon - wouldn't want to cause more tissue trauma and bleeding. I have used baking soda to absorb odors in smelly wounds - layered between 4 x 4's - but not touching the skin. Do they make menstrual pads with odor absorbing stuff? (I'm a little beyond the need for them, thank goodness :chuckle )

Flagyl taken po or applied cream to the wound (difficult in this case with that much drainage) can reduce the bacteria which is contributing to odor.

Sounds like you are doing a great job of helping her stay as normal as possible!

Gail

leslie :-D · Aug 13, 2004

saribeth,

you mentioned you're concerned about her eventually vomiting fecal matter.

is she becoming obstructed? bowels sounds still active?

because if that's a possibility, she should not be eating at all.....

i'm assuming you are worried because of tumors in her pelvic cavity?

saribeth · Aug 14, 2004

saribeth,
you mentioned you're concerned about her eventually vomiting fecal matter.
is she becoming obstructed? bowels sounds still active?
because if that's a possibility, she should not be eating at all.....
i'm assuming you are worried because of tumors in her pelvic cavity?

Her bowel sounds are like a construction crew down there! And yes she does have one huge tumor in her pelvis and her appetite is null...she has had one bout of N&V so far...thanks so much Janie

saribeth · Aug 14, 2004

I would be very leery of inserting a tampon - wouldn't want to cause more tissue trauma and bleeding. I have used baking soda to absorb odors in smelly wounds - layered between 4 x 4's - but not touching the skin. Do they make menstrual pads with odor absorbing stuff? (I'm a little beyond the need for them, thank goodness :chuckle )
Flagyl taken po or applied cream to the wound (difficult in this case with that much drainage) can reduce the bacteria which is contributing to odor.
Sounds like you are doing a great job of helping her stay as normal as possible!
Gail

Thanks Gail...hope you are not bound for Florida until they are cleaned up from Charley...he is heading here incognito, trop storm, this evening...anyway I was not able to see enough to insert a tampon in there...and yes she is on Flagyl...the odor is not good as you can imagine, but only when it is draining which is every time she stands up, and that is only when she showers which is about q o d...take care and many thanks again Janie

leslie :-D · Aug 14, 2004

it might be helpful (if you're not doing this already) to have her sit on a shower chair, with the bucket underneath it ( the ones that slide into place) so it could drain freely w/o patient seeing anything....

best of luck to you.

leslie

DMB FAN2 · Aug 18, 2004

Another thing to watch for is bowel obstruction- esp if she has bowel involvement......I have used Octreotide (sandostatin) injections to decrease the bowel secretions and helps the n/v....Just a thought

saribeth · Aug 18, 2004

Another thing to watch for is bowel obstruction- esp if she has bowel involvement......I have used Octreotide (sandostatin) injections to decrease the bowel secretions and helps the n/v....Just a thought

Thanks so much, I will keep that in mind...she is declining rather quickly so hopefully she will be spared...Janie