Colocutaneous fistula management in a dehisced wound: a case study.

A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions.

[Patient anxiety and satisfaction in coloproctological operations]. / Patientenängste und -zufriedenheit bei koloproktologischen Operationen.

BACKGROUND: Patients' emotional internal views related to coloproctological operations were examined, especially the relation between anxieties and satisfaction with treatment, including possible moderator variables such as age, gender, and control beliefs. PATIENTS AND METHODS: For 328 patients with operations on the rectum versus colon operations, intensity of anxiety, quality of anxiety, and their course was assessed. Likewise, satisfaction with medical care, subjective success of treatment, as well as control beliefs regarding illness and health were measured. The data were analyzed by means of analysis of (co-)variance, regression analysis, and discriminatory analysis. RESULTS: The emotional internal view turned out to have a greater influence than the objective severity of the operation. This also concerns specific, coloproctology-related contents of anxiety (e.g., anxieties concerning an anus praeter). For coping with anxiety, variables of a "talking medicine" are relevant. For this purpose, engaged communicative nursing care is important, though it cannot compensate for deficiencies in doctor-patient-communication. The latter must take into account the higher intensity of anxiety among younger patients as well as feelings of insecurity related to the hospital dismissal. CONCLUSION: These findings suggest the following improvements: the information provided by the physician should be more sophisticated, the clarification of diagnosis should take place as soon as possible, and the communication of the diagnosis should be combined with the reinforcement of internal control beliefs. This should apply to the transition to outpatient treatment as well.

Women's colonic digestive health.

Digestive problems in women are common and sometimes debilitating. Twenty percent of women suffer from irritable bowel syndrome, 20% have constipation, and all American women will need screening for colon cancer, the number two cause of cancer death in women. This article reviews management of these disorders as well as lower gastrointestinal symptoms associated with menses, hysterectomy, fecal incontinence, and rectal bleeding.

Bowel obstruction.

Bowel obstruction is a serious problem requiring prompt medical intervention to relieve intestinal distention, restore intravascular volume, and correct fluid and electrolyte balance. If these efforts fail, either curative or palliative surgical interventions become necessary. Oncology nurses are important members of the healthcare team caring for patients with bowel obstructions. Accurate nursing assessments are critical to monitoring the effects of these therapies and key to reducing the risk of preoperative and/or postoperative complications.

Perianal skin care for persons with an ileoanal reservoir.

The perianal skin care and management of skin irritation I have described has been effective in 98% of my patient population. These patients exhibited mild to moderate perianal skin irritation, which was resolved within 24-48 hours. In 2% of the patients, we used stronger antifungal preparations (e.g. Mycostatin Power, Mycolog Cream) or steroid products. These products are expensive and require a prescription. Moreover, the steroid products can only be used for a short period of time, as prolonged use can cause damage to the skin. The ileoanal reservoir is an excellent choice for patients wishing to avoid a permanent ileostomy. Patients selected for this procedure should be under the age of 40 (with a few exceptions) and mentally competent. They must have good anal sphincter control and be highly motivated to follow instructions to obtain the highest satisfaction and the best results from this surgery. The procedure has proven effective when performed by a surgeon who is successful in this field on a patient who is well-educated regarding the surgical procedure, post-operative care, and most importantly, the perianal skin care. This exemplifies a successful candidate for the ileoanal reservoir.