A Little
Ostomy Test
Edited from an article by our
friends in Canada
1. While washing your skin and stoma you
notice spots of blood on your cloth. Your
immediate reaction is:
a) Notify your
doctor at once.
b) Panic!
c) Apply gauze to
the stoma.
d) Continue with
care of your stoma and apply a new appliance.
The answer is d. Do not become frightened when there are spots of blood on the cloth when wiping the stoma. This is from the many blood vessels lining the stoma. Always cleanse and care for the stoma gently. If the stoma is bleeding profusely (filling the appliance), then notify your doctor at once.
2. Your appliance has been on for 2 days and
you experience a burning uncomfortable
sensation around your stoma. You:
a) Ignore it. It
seems to come and go anyway.
b) Wait until the
designated day to change your appliance.
c) Take a cool bath.
d) Change your
appliance immediately.
The answer is d. Ideally your appliance may stay on for five to seven days. However, if you experience burning or itchiness around the stoma, discomfort or pain around the stoma or discoloration of the adhesive, change your appliance regardless of the day. These signs usually indicate leakage. Stool or urine on the skin is very irritating. In addition, itching or irritation under the pouch may also be due to dehydration. If you are pretty sure the appliance is not leaking and there is nothing externally wrong with it, drink a few glasses of water rather than remove the appliance. If the symptoms persist, change your appliance. Don't be a hero. When it bothers you, change.
3. When you remove your appliance, you notice
the skin around the stoma is reddened. To
treat it you:
a) Apply cool
compresses for a short period of time before reapplying your appliance.
b) Apply a
protective powder such as Stomahesive or Karaya to reddened skin areas,
remove any excess and continue with
reapplying your appliance.
c) Apply a soothing
cream or ointment to the reddened skin areas.
d) Use an alcohol
wipe on your peristomal skin.
The answer is b. It is important to observe the skin around the stoma. Use a mirror to help observe the skin and stoma. If the skin appears reddened, irritated or weepy you may require a protective powder. You may need to change your appliance every two or three days until the skin heals. While creams and ointments may be a reasonable solution for skin irritation in other areas of your body, they may not be useful around your stoma because your appliance will not adhere to moist or oily skin. Cool compresses may be soothing but cannot heal the skin. Alcohol will dry the skin which may cause it to itch. As an added note, hair growth around the stoma can be quite painful when removing the appliance. Remove excess hair with an electric razor or scissors. A straight edged or safety razor should not be used because of the risk of irritation to the skin and cutting the stoma. Ostomy adhesive removers may help reduce hair pulling when removing the pouch.
4. Your neighbors invite you to a pool party.
You:
a) Decline the
invitation since you cannot swim with an ostomy.
b) Limit your fluid
and food intake for 12 hours prior to the party so your stoma is not
active.
c) Accept the
invitation.
d) Go in the pool,
and then worry that your prosthetic will probably leak.
The answer is c. If you enjoyed swimming before the operation, continue to swim after. For extra security while swimming, you may want to picture-frame the adhesive part of your appliance with paper or waterproof tape or apply a skin sealant, for example--Sween prep, directly over the adhesive. Printed rather than solid colored bathing suits help to camouflage the outline of the appliance. Some women prefer bathing suits with skirts and some men prefer boxer-style trunks, but snug fitting suits may be worn. A lightweight panty girdle may be worn to hold the appliance firmly in place. If you have an ileostomy, it will work whether or not you eat. When the stomach is empty the discharge is liquid, highly acidic and gassy. Skipping meals or limiting fluid intake leads to dehydration and/or electrolyte imbalance.
5. Six weeks after your operation you find
your appliance no longer fits. There is skin
showing around the stoma. You:
a) Notify your Enterostomal Nurse.
b) Fill the skin spaces with protective powder or paste.
c) Re-measure your stoma using the measuring guide.
d) Figure that is just the way it works.
The most correct answer is c. Immediately after the operation, the stoma is swollen due to the handling of the bowel during surgery. It may take a few months for the swelling to disappear. In the beginning, you need to re-measure the stoma each time you change the pouch. If you live in an area where there are ET nurses, make an appointment to see one about a month after surgery, just as a follow-up. It is important that the appliance fits loosely against the stoma. You need to allow room for the bowel to expand as contents pass. This is especially true for ileostomates. To allow for bowel expansion, usually cut the opening l/8 of an inch larger than the stoma size. The newer, more aggressive barriers like Flextend or Durahesive may be cut to the exact size of the stoma. Skin spaces are filled with protective powder or paste. Urostomate need to be careful with pastes. They may reflux and cause infection.
6. The warm weather is here and you are
anxious to resume sports. The doctor has agreed
that you are ready for more activity. You know
that:
a) Having an ostomy interferes
with your ability to exercise.
b) You can only be a spectator.
c) During any physical activity it is important to increase your fluid intake,
not limit it.
d) You may
participate, but you will get ill.
The answer is c. The large bowel absorbs water and electrolytes like sodium and potassium. With the removal of or bypassing of part of the colon or bladder, a person with an ostomy tends to lose fluid and electrolytes through the stoma. An increase in fluid and electrolyte loss is associated with excessive perspiration, physical exercise, a hot climate or vomiting. Loss also occurs with high ostomy output, sometimes seen with an ileostomy. If you have an ileostomy and are emptying your appliance more than 8 times a day or stool output is greater than l 000 cc per day, you have high ostomy output. With a high ostomy output, there is a potential for dehydration and electrolyte imbalance to occur. There is no reason why an ostomy should limit your participation in sports with the possible exception of rough contact sports where injury to the stoma may occur. However, specially designed shields may be used to protect the stoma. Many individuals who have an ostomy are golfers, hikers, runners, swimmers, skiers, sky divers...it is important to remember that during periods of physical activity or high ostomy output, your fluid intake should be increased not limited.
7. You are invited to fly south during the
March holiday and you:
a) Decline. You
cannot travel with an ostomy.
b) Readily accept, but plan ahead for potential problems.
c) Plan to purchase your supplies when you arrive.
d) Pack all your ostomy supplies in the luggage you check through baggage.
The answer is b. You can travel with an ostomy but it is wise to plan for potential problems. Helpful hints when traveling:
· Always take triple the amount of supplies you would normally use for that period.
· Never check all of your ostomy supplies with airline baggage.
· Emergency supplies should be placed in your carry-on luggage, and stored in a cool place.
· A doctor's letter may avoid unnecessary questions during a luggage check.
· Check in the yellow pages for ostomy supply vendors if supplies or assistance are required.
· Locate the local United Ostomy Association Chapter if problems or questions occur.
8. You are home from hospital and are feeling
lonely and depressed. You:
a) Visit, phone and
talk to friends.
b) Contact the local Ostomy Chapter, and arrange to go with a friend to a
meeting.
c) Get busy with a hobby, help someone else with their challenge.
d) Plan an outing to have some fun.
All these solutions may help. You have been through a tremendous amount of stress. It is not unusual or unexpected to have days when you feel sad or depressed. These feelings are normal and pass with time. It is important to express your feelings. You may cry, be hostile, angry, nasty and react in ways that are unusual for you. Remember you are not alone. Family and friends, as well as other individuals who have an ostomy can be a great support.