RISING TO THE CHALLENGE

Objectives
RISING TO THE
CHALLENGE
Promoting Person Centered Care: Resident-Directed
Ostomy Mangement in the Long-Term Care Setting
Angela M. Braswell, RN, MS, CWOCN
November 07, 2015
NE Region WOCN Society Symposium
Past Medical History
Approximately 10-11 years ago Dennis S. was
diagnosed with fulminant pancreatitis with residual
pancreatic insufficiency and resulting ileostomy.
The ileostomy was unable to be reversed due to
severe adhesions and the patient subsequently
developed 2 enterocutaneous, high-output, fistulas
(ECF).
Dennis had experienced 5 hospitalizations in the last
year related to ARF and dehydration with mental
status change.
This is Dennis S.
• Retired Naval engineer
• Lives independently
• Lost his wife to breast
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cancer approximately 1 ½
years before initial
hospitalization
Has three children, multiple
grandchildren
Enjoys cooking, especially
stews and soups
Appreciates a good Irish
shanty
Is as kind as he he stubborn
“I manage fine on my own”.
Demonstrate Understanding of multidimensional
considerations in managing complex situation:
1.Identify barriers to optimal ostomy management in
long-term care environment.
2.Explore treatment options in the management of
ileostomy and enterocutaneous fistulas (ECF).
3.Reinforce concept of person-centered care within
the long-term care environment.
Dennis S.
Current Health Concern
71 y.o. male, full code,
admitted from acute
rehab facility on 10/7/13
to SNF for continued
rehabilitation of left
brachial plexus injury s/p
hospitalization for acute
renal failure, hepatopathy,
and rhabdomyopathy.
Medication List
• Allopurinol 20 po mg QD
• Aspirin 81 mg po QD
• Pancrelipase Caps po 4 before
meals
Protonix 40 mg po QD
Lisinopril 40mg po QD
Nectar-phos 1 packet QD
Octreotide 100mcg sq q 8hrs
Lomotil q 4 hrs prn output
ileostomy
• Clonidine 0.1mg nightly
• Consume 3L/day, “2 cups of
coffee with this amount”
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Abdominal
Assessment
•Stoma
Stomatized ECF
characteristics
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Height
Lumen
Color
Shape
Location
Ileostomy
•Topography
•Skin condition
•Output
Stomatized ECF
Problem Solving…
General
Guidelines
1. Prepare all items
needed prior to
beginning pouch
changes.
2. Remove pouching
system, can use
adhesive remover.
3. Gently cleanse
peri-stomal skin
with water only.
4. Apply
stomahesive
powder.
5. Spray over
powder with
Cavilon No-Sting
Barrier.
Maintainin
g Control
Resident Outcomes