nursing student needs help with colostomy care

I know it is not allowed to give/get medical advice here, so I hope I am wording this the right way as so I can get ideas, direction, good nursing student care advice...

I am a CNA that does private home care. Just finiched Nursing school and am getting ready to take the NCLEX, YAY!! I am taking care of a woman who has a decending colostomy which she has had for one year. She is very discouraged and does not want to leave the house for in fear of "something happening". The complication is she has a grapefruit size hernia that resulted after the surgery It makes fitting the appliance difficult because there is always a small space between the appliance and her skin. She has tried many, many appliances and the only one that is a near best fit is the Hollister two piece. The problem is that often stool gets underneath and the appliance lifts and has to be changed almost everyday. The other problem is it sometimes happens when she is sleeping and she wakes up in a mess. This happened last night, she was very upset and discusted, discouraged... I helped clean her up but mostly tried to help her deal with this emotionally. I wish I always knew the right things to say in these situations... but I guess that comes with time/experience.

I have been thinking about this all day as to what kind of advice to give her. I know she doesn't have an ostomy Nurse but I guess her primary doctor could refer one?? Does anyone have any experience working with colostomyies that are on top of hernias. To make matters worse, during this surgery 3/4 of her bladder had to be removed so she is totally urine incontinent so must wear a depends at all times. And it is difficult to fit that. At night she wears a tabby diaper, not a pull up.

If you cannot give me advice.. how about just some encouragement or a direction to go in. I really enjoy taking care of this woman at home and just want to give the best care I can while I am with her.

Thanks,
Bea
I guess my first question would be: is the woman in a position to have the hernia repaired? That would solve more than one problem.Other than that, I think an ostomy consult would be in order to individualize the treatment plan. I'm not sure how that would happen outside of a facility....surely the gastroenterologist could help with that.

thanks for the reply.. Unfortunatly it isn't able to be repaired, she has way too many risk factors going on. She is 72 years old, and has many health issues. She is so disappointed by all this.. just looking for ideas on how to help her out.

Has she tried stomahesive paste? My son had a colostomy from the time he was 2 months old. I used to have problems with stool leaking underneath the wafer. I used 2 piece colostomy bag with a wafer that you "snap" the bag on. After I removed the used system, I would cleanse the stoma and the area around with soap and water, pat dry, I would then measure the stoma opening and cut the opening out, I would take a qtip and gently lift the stoma thru the opening, and then would stoma paste to fill in the gaps around the stoma and the opening. This pretty much eliminated any leakage for my son. The GI doc should be able to make a reccomendation to a ostomy nurse for you patient. Hope this helps!NiceNurse LPN

thank you! good suggestion. It sounds like that may be very helpful. I was wondering if there was some kind of "filler" to fill in the gap" that makes perfect sense.

I do wound/ostomy care in LTC and I lovelovelove a product called Convatec Eakins Cohesive. Its a sticky wax type product that can be molded to fill in the gaps under the wafer.Good luck

Quote from optimistI do wound/ostomy care in LTC and I lovelovelove a product called Convatec Eakins Cohesive. Its a sticky wax type product that can be molded to fill in the gaps under the wafer.Good luck

My husband has an illeostomy. He's had it for 2 years. We really had a lot of trouble at first too. We've really had good luck with the seals or rings that other people have mentioned. Several companies make them. An ostomy consult would probably help too. I've found that the gastroenterologist and the surgeons don't really know a lot when it comes to after care. Good luck to her and you. There are also some support groups on the internet. They are a lot like this site. You ask a question and someone answers it. They have really been helpful as well.

I'm surprized she didn't have an ostomy consult before being discharged. It's part of the discharge protocol within my hospital. The pastes and wafers are the only thing that will help.We may be a bit more blunt up here in the Great White North but more than patient has been told ostomy or death which is preferable?There are times though, when you have to wonder what the surgeon was thinking. 98yo, arthritic hands, bowel obstruction. Seen more than a few of those over the years. My friend is an ostomy care nurse and even she says when she's old and infirm she'd decline an ostomy.

As far as I know, she did have a consult before leaving the hospital. She has had the colostomy for a year now... but the surgery resulted in a grapefruit size hernia several months later. So that is why things have changed. And I'm sure the hernia shifts and changes in size which doesn't help. I will tell her to look into these pastes. They seem like they make help here.Thank you all for your suggestions.