CASE STUDY

Case study

Case study

The evaluation and management of stomal and peristomal difficulties during the early postoperative time span are critical to thriving adaptation to a new ostomy. While many types of peristomal issues can influence Angelina's psychological and emotional health after ostomy surgery, this article focuses on the impact of several common physiologic complications: stomal necrosis, mucocutaneous separation, prolapse, retraction, and stenosis. WOC nursing management throughout the preoperative and intraoperative phases is considered in detail. Emphasis is placed on WOC nursing care during the early postoperative period because, as Duchesne and coinvestigators noted, “nearly 95% of the patients were cared for by an enterostomal therapist, [and this] was associated with a sixfold decrease in stoma complications.”( Duchesne, 2002, 964)

Epidemiology

As no consensus currently exists on defining stomal complications, the nomenclature constructed by Colwell and Beitz is used in this review. Their working definitions are founded on an extensive reconsider of the publications and the input from a nationwide review of ostomy care experts. The clues developed by their study provides content validity for definitions of the terminology utilised in this review. (Efron 2008 52)

Preoperative and Intraoperative Factors

The worldwide Ostomy Association supports preoperative therapy for all persons undergoing stomal surgery to double-check that they are fully aware of the advantages of the procedure and essential details about dwelling with an ostomy. They further advocate that all persons undergoing surgery should have a well-constructed stoma placed at an appropriate site, with full and proper consideration of Angelina's comfort. (Minkes, 2006)

Based on a systematic literature, Colwell and Gray concluded that insufficient evidence exists to determine whether preoperative stoma site marking reduces the incidence of postoperative complications and additional research is needed to provide an evidence base for this centerpiece of ostomy nursing practice. Nevertheless, overwhelming clinical experience led to a joint statement from the American Society of Colon & Rectal Surgeons and the Wound Ostomy Continence Nurses Society stating that Angelina undergoing intestinal ostomy surgery should have preoperative stoma site marking by an experienced, educated, and competent clinician. (Carmel 2004 118) The Wound Ostomy Continence Nurses humanity and the American Urological Association have issued a junction declaration supporting preoperative stoma site assessing for individuals undergoing urostomy surgery. These position statements caution that poor stoma placement can lead to unavoidable postoperative morbidity, including pain, leakage from the pouching system, peristomal skin irritation, fitting challenges, and impaired psychological health.Ideally, the stoma should be sited after placing the Angelina in various positions (standing, sitting, and supine). The clinician should assess abdominal contours and choose a site in the rectus sinew approximately 2 inches from the planned incision where 2 to 3 inches of flat adhesive barrier can be directed, while maintaining a apt distance from the umbilicus and band line. The ostomy should furthermore be put at a suitable distance from any blemishes, impaired skin, bony prominences, and skin creases likely to weaken optimal adherence of the pouching system. (Wound 2005 256)

Intraoperative events can considerably influence postoperative conclusions and difficulty ...