a practical question about colostomy

[SamZ]

Hi

does anyone know following the formation of a colostomy, is the patient most likely to denial the existance of the colostomy (as denial is the first step in the grief process) or is the patient gonna reject relatives and friends (coz he thinks they won't like him anymore since he has got this poo bag attached to him)?

Many thanks!!

[XB9S, BSN, MSN, EdD, RN, APN]

I guess it very much depends on the patient and the support he gets both pre and post operatively. Is it an emergency procedure or elective, did he have preparation with stoma care nurses? Was he given options as to where the stoma was going to be sited. If you could give a little bit more information and background to your question we may be able to give you a more informed answer.

[K+MgSO4, BSN]

If you are in Oz talk to some stomal therapists specialist nurses who assist in caring for pt with stomas. Google the Colostomy association. 2 of my colleagues were part time stomal therapists and work for the association as well.

[K+MgSO4, BSN]

If it is an emergency procedure they are going to be very shocked about it. They will more than likely of had a laporotomy and have pain issues nausea and vomitting drain tubes IV devices as well as the grief of a stoma. They may of just discovered that they have cancer and are dealing with 100 things at once, and the nurses are worried that they will develop RTI and make them deep breath and cough which hurts like hell. We make them walk which hurts and get them out of bed. They may have family issues such as child care or someone to look after a aged parent to deal with.

They have tons to deal with and of course they are going to have issues with their stoma. What I usually tell my pt is that this bag is not nice but it is temporary (depending on their surgery and discussing it with the surgeon) and it SAVED THEIR LIFE.

I do it in a very nice and gentle way at the same time getting the pain team to review pain management, anti emetics charted explaining the rational for deep breathing and coughing and mobilising social wok to help with their home circumstances and taking the time to let them talk about their shock.

If it is a planned procedure for cancer they will of been seen by stomal therapy in the pre admission clinic and given education on the "bag" and what to expect. They still need time to grieve but they are often more adjusted to what is happening because they have had time rather than the emergency pts.

Very few reject their relatives as they mostly recognise that they are going to need some help in the short time at least to complete their recovery as we discharge so early from hospital. But for those that push family away we talk to them about their feelings when they come flooding out at 3 am or in the shower in the morning. We offer advice and suggest that their family would rather them alive with a stoma than dead. (in tactful terms) Social work can organise more counciling if required and have them met their GP or nurse or have RDNS/ PAC come into them for care.

[SamZ]

hey everyone, thanks a lot for your reply. you are right, it is really depends on the situation and how prepared the patient is. this was just a very vague question that i have been asked without any clinical backgrounds, and i think that was why i found it was hard to answer. as both of you have suggested, i will have a talk with the stomal therapist or stomal nurse in the hospital. Thx again!!

[Fiona59]

Karenmarie: sounds like your unit handles ostomies like mine does. Self care starts day one. Only remember one patient throwing a wobbler over having to and he seemed to think a homecare nurse would stop by the house to empty and change it for him. We think he slept through the information sessions.

One of the more frequently asked questions in our younger patients concerns their sex lives as in is it over.