Nursing management of a patient with a urinary diversion
| Autor: | Rosemary C. Watt |
|---|---|
| Rok vydání: | 1986 |
| Předmět: |
Postoperative Care
medicine.medical_specialty Rehabilitation Oncology (nursing) business.industry medicine.medical_treatment General surgery Urinary diversion Specialty Urinary Diversion Sitting Skin Diseases digestive system digestive system diseases Quadrant (abdomen) surgical procedures operative Patient Education as Topic Stoma (medicine) medicine Humans Intensive care medicine Sexual function Nursing management business |
| Zdroj: | Seminars in Oncology Nursing. 2:265-269 |
| ISSN: | 0749-2081 |
| DOI: | 10.1016/0749-2081(86)90116-6 |
| Popis: | HEN PERMANENT urinary diversion is included in the treatment plan for a patient with cancer of the bladder, the first and immediate preoperative need of the patient and family is information. The patient who has decided to have this radical procedure as a condition for cure or remission needs to understand the proposed surgery and the consequences of living with a stoma. Most likely, the patient will be concerned and worried about the stress and pain of surgery, body appearance with an abdominal stoma, how the new method of urine elimination will be managed, sexual function, and social rejection. In addition, the patient may fear that the disease is inoperable or that the cancer may recur even if it is removed. Financial worries about the cost of surgery and hospitalization are common. Preoperative teaching and counseling is of major importance for successful rehabilitation. The patient must be reassured that the stoma will be managed by skilled professionals until he is ready to learn, and that he, or a delegated person, will be taught stoma care under supervision. Prior to surgery, stoma equipment may be demonstrated and the patient should be told that a normal stoma is red and moist and around one inch in diameter. There should be continuing reinforcement that the stoma will be manageable, that urine will be collected in an odorproof pouch, and when clothed, there will be no visible evidence of the stoma or its equipment. The determination of the stoma site is done preoperatively by the ET nurse or the surgeon. The site is usually on the right lower abdominal quadrant for an ileal loop diversion or on the left lower quadrant for a colon conduit. The site selected should avoid abdominal scars, folds, and creases, and bony prominences. The patient should be observed in the standing (if possible), sitting, and supine positions prior to site selection. When the patient is in the sitting position, he should be instructed to bend slowly forward as if to pick up an object. All folds, creases and uneven contours will be accentuated in this position and these potentially troublesome areas should be avoided for a stoma location. In addition, the patient should be able to see the site so he will be able to manage the stoma. The specialty of ET nursing provides specialized care to patients who have surgeries resulting in enterostomas. The ET nurse does not replace the nursing staff. Instead, she is an additional member with specialized knowledge and experience necessary for the patient’s optimal recovery and rehabilitation. A preoperative visit from a person who has successfully lived with a urinary stoma may be helpful, if desired by the patient. The visitor should be the same sex and approximately the same age as the patient with a similar lifestyle. These trained visitors are most often members of the UOA or the ACS |
| Databáze: | OpenAIRE |
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