Ostomy Information PDF

OSTOMY What is an Ostomy? An ostomy is a surgically created opening (stoma) in the body to allow for the elimination of bodily waste. This is often needed when part of the digestive or urinary tract is removed or bypassed. The stoma allows waste to exit the body when normal bodily fu...

OSTOMY What is an Ostomy? An ostomy is a surgically created opening (stoma) in the body to allow for the elimination of bodily waste. This is often needed when part of the digestive or urinary tract is removed or bypassed. The stoma allows waste to exit the body when normal bodily functions are not possible due to medical conditions like cancer, Crohn's disease, or trauma. Stoma : The hole or opening in the body. No sphincter control: Since there’s no control over the output from the stoma, patients must wear a pouch to collect the waste. Types of Ostomies Colostomy ○ Output: Thicker, formed stool. ○ Typically involves the large intestine. Ileostomy ○ Output: Thicker, formed stool. ○ Typically involves the large intestine. Urostomy ○ Output: Primarily liquid or gas, related to urine. ○ Diverts urine from the kidneys through a stoma. Characteristics of a Normal Stoma: Color: Pink or dark red. Moist: Stoma should be moist, which is a healthy sign. Painless: The stoma itself doesn’t have pain receptors, so it should not hurt to touch. Size: Varies based on the patient and surgical procedure. Shape: It may be flat or protrude slightly, and some stomas have one or two openings. Pouching System used to collect stoma effluent (waste). It's essential to have a secure seal and protect the skin around the stoma to prevent irritation. There are two primary types of pouch systems: ○ Two-piece System Components: Separate barrier and pouch. Color Coding: Items are color-coded (e.g., red, blue, green), with red being the most common size.  Barriers: Can come in soft convex, flat, or convex options to fit different body shapes. Draining Opening: Velcro or lock-and-roll system for easier emptying. ○ One-piece System Cut to Size: A single unit that is worn directly on the skin. Draining Opening: Can have a lock-and-roll system for easy closure and emptying. Disposable Option: No draining opening, ideal for swimming and other activities. Barrier Types and Fit Pre-Cut vs. Cut-to-Fit: Cut-to-fit barriers are often preferred, as stomas can change size over time. The stencil is used to measure the stoma and cut the barrier accordingly. ○ Cut-to-fit requires trial and error before patient can perfect the sizing Barrier Wear Time: Barriers last 5-7 days, depending on the patient’s activity and body condition. Ceramide-infused Barriers: These help maintain skin integrity and prevent water loss, forming a protective, waterproof layer. Fitting Considerations: Flat Barrier: Best for firm abdomen, post-op edema, or minimal movement (used in hospitals). Soft Convex Barrier: Best for patients who are transitioning home or have a more active lifestyle. Ostomy Accessories:: Barrier Rings: Placed under the barrier to provide an extra layer of protection, often made of ceramide to help maintain skin health. Belts: Provide extra pressure to help ensure a better fit for the barrier. Powder: Used for damaged skin, helping to dry out the area before applying a new barrier. Burping the Pouch: Some pouches have filters that help release gas, preventing odor and ballooning. Preventing Leakage Regular Emptying: Ensuring the pouch is emptied regularly is critical to prevent leakage. Correct Fit: Choosing the right pouching system and making sure the barrier fits snugly around the stoma is key to preventing leaks. Cost of Having an Ostomy Government Funding: $975 annually (paid in 2 installments). Private Coverage: Annual costs can range from $1,500 to $4,000 depending on the patient’s needs. Hollister Products: ○ Hollister’s ostomy products are sold through pharmacies (not directly from the company). ○ A year's supply can cost around $5,000, with one-piece systems being cheaper than two-piece systems. Insurance and Coverage (ODB): Some Hollister ostomy products are covered under the ODB program, and one-piece soft convex systems are included. ADP Program: Minimum spend of $1,500 to $4,000 annually for ostomy supplies. Secure Start Program: Hollister offers a patient support program that provides access to free samples and guidance on product selection. Patients can enroll via the website or paper forms. Insurance and Coverage Use skin-protective wipes to gently remove barriers and protect the peristomal skin. Check the fit regularly, as stomas can change shape, and a snug fit is essential for preventing leaks. Rotate application sites: The skin around the stoma can become irritated, so rotating the location of the stoma is important.  COMPRESSION THERAPY/SOCKS Take off end of day Do not wear while sleeping Need to be standing and applying pressure for it to work Over the counter vs behind the counter compression socks ○ How would you measure them? OTC by shoe size behind/rx: need to get measures from knee to ankle 3 things needed on rx to get compression ○ Length (thigh high, knee high, etc), strength, diagnosis ○ Does the doctor need ankle and calf measurement size? NO Mild, moderate, severe Travel Socks = Compression Socks. The terms are often used interchangeably, but "travel socks" usually refer to compression socks worn during long trips, such as flights, to prevent swelling and improve circulation. Why Use Compression Socks? apply pressure to your lower legs, which helps promote better circulation and prevent blood from pooling in your veins. useful for improving venous return, i.e., helping blood flow back to the heart more efficiently. help manage swelling and reduce discomfort in the legs. Reduce the Risk of Deep Vein Thrombosis (DVT) How Compression socks fit Fit by Shoe Size: For lower strength compression (15-20 mmHg), socks are generally fitted based on shoe size. Tighter Fit Around Ankles: Compression is strongest at the ankle and gradually decreases as you move up the leg, improving blood flow upwards. Proper Sizing: Ensure the socks are the right size for your legs to work effectively. If they’re too tight, they can cause discomfort or impair circulation; too loose, and they won't provide the intended benefits. Signs You Might Need Compression Socks: Tired, achy legs Spider veins Swelling or edema in the legs, especially after standing for long periods Varicose veins or the beginning signs of them Indications for use  Pregnancy: Common due to the increased pressure on veins and swelling. Standing for Long Periods: People who are on their feet all day, such as healthcare workers or retail employees. Preventative: For those at risk of poor circulation or varicose veins. Flying: For pilots, flight attendants, or anyone who spends long hours on a plane Compression Strengths (Measured in mmHg): Compression strength refers to the amount of pressure exerted at the ankle: ○ 15-20 mmHg: Light compression; commonly used for mild swelling, tired or achy legs. These are not usually covered by insurance and are generally available over-the-counter. They are typically based on shoe size and are the least expensive. ○ 20-30 mmHg: Most common medical grade compression, used for moderate vein problems, swelling, and varicose veins. Often requires a prescription to be covered by insurance. ○ 30-40 mmHg: Used for severe conditions such as DVT, ulcers, or venous insufficiency. These are more difficult to put on and are not suitable for people with poor dexterity. ○ 40+ mmHg: These are not commonly used but may be prescribed for very severe venous conditions or other specific medical issues.  NALOXONE 21 Canadians die each day from opioid overdose (from 2024) (2019 – 12 people) 75 opioid related position emergency visits 96% of opioid overdose deaths are accidental Leading cause of accidental death in Canada Opioid Crisis Driven By... ○ Contaminated illegal drug supply Contamination with Fentanyl, where just a few grains of Fentanyl can be fatal ○ Prescription opioids High rates of opioid prescribing contributes to increased exposure to opioids and their potential risks ○ Opioid tolerance and dependence Long-term use of prescription opioids can lead to tolerance, meaning higher or more frequent doses are needed to feel the same effects This pattern of use can cause your body to become dependent on opioids and can develop into an opioid use disorder. If you stop taking opioids for any period of time, your tolerance can rapidly decrease, which means that taking a dose you previously used can be fatal ○ Barriers in accessing harm reduction and treatment services and supports ○ Stigma Stigma surrounding substance use, which can lead people to hide their drug use, discourage people from seeking health and social services, and can reduce the quality and availability of services received What is an Opioid? Opioids are drugs with pain relieving properties that are used primarily to treat pain Opioids can also induce euphoria (feeling high), which gives them the potential to be used improperly EXAMPLES: Codeine Hydromorphone Morphine Fentanyl Oxycodone Methadone Demerol Heroin Buprenorphine (Suboxone) Short Term Effects of opioids ○ Drowsiness ○ Constipation  ○ Impotence in men ○ Nausea and vomiting ○ Euphoria (feeling high) ○ Difficulty breathing ○ Headaches, dizziness and confusion, which can lead to falls and fractures Long term effects ○ Increased tolerance ○ Liver damage ○ Infertility in women ○ Worsening pain (known as "opioid-induced hyperalgesia") ○ Physical dependence ○ Substance use disorder ○ Overdose Opioid Tolerance If you have been taking opioids for a period of time, your body becomes accustomed to or tolerant of that opioid dose may require increasing amounts of the opioid to get the same effect If you stop taking the drug for a few days and then start taking the drug at the same dose you were used to, it may increase chances of an overdose. ○ This is because you lose tolerance to the medication when stopping it, even for a few days. You are likely to experience withdrawal symptoms when you lower your opioid dose quickly or you suddenly stop taking it Withdrawal symptoms: ○ chills, diarrhea, nausea and vomiting, insomnia, sweating, irritability, agitation Substance Use Disorder classified as a persistent use of drugs, despite the harms and adverse consequences to oneself and others, as a result of their use When someone is affected by substance use disorder, they crave the drug and continue using it despite the harmful effects. ○ The drug becomes the focus of their feelings, thoughts and activities Opioid use disorder also changes the brain and the body in ways that can make it hard to stop using. ○ This is because the body gets used to a regular supply of the drug. If you stop using the drug, or lower your dose quickly, you will likely experience withdrawal symptoms Overdose when a patient takes too much of an opioid Since opioids affect the part of the brain that controls breathing, when someone takes more opioids than their body can handle, their breathing slows. This can lead to unconsciousness and even death Patients are at a higher risk of overdose if they take: ○ An opioid with other drugs including sleeping pills (benzodiazepines), anxiety medication and muscle relaxants ○ with alcohol ○ not prescribed for you Naloxone An “opioid antagonist” used to reverse the effects of opioid overdose Naloxone has a stronger affinity for the opioid receptor than the opioid itself When you take an opioid, it affects certain receptors in your brain. ○ Naloxone works by kicking opioids off the receptors in your brain and binding to those receptors instead. This temporarily reverses or blocks the effects of opioids on your body Temporary antidote A person can fall back into overdose within 30 minutes ○ The effects of opioids last much longer than naloxone ○ This means that the effects of naloxone are likely to wear off before the opioids are gone from the body, which causes breathing to stop again If naloxone is used right away, it can restore breathing within 2 to 5 minutes Naloxone only works if a person has opioids in their system ○ The medication has no effect if opioids are not present Naloxone is readily available in pharmacies across Ontario without a prescription How effective is naloxone? Use of the kit reverses the overdose at least 90% of the time Can naloxone be administered by anyone? Yes can be administered to all ages, including those who are pregnant, who have heart or kidney disease, or who have any other health condition ○ Naloxone is very safe and has no major side effects ○ Giving multiple doses is also safe and ok  Often times with Fentanyl opioid overdoses, patients may required more than one naloxone dose Administering Naloxone Step 1: Shake and Shout ○ You want to see if they are going to respond or if they are unconscious ○ If they don’t respond, try rubbing your knuckles on the center of the persons chest or beck ○ Look for signs of opioid overdose soft/no breathing Pinpoint pupils (contricted) Cyanosis, cold skin, limp body Doesn’t respond to shouting Step 2: Call 911 ○ Naloxone is a temporary antidote. You want to make sure an ambulance is on the way Step 3: Give injection ○ Break ampoule, pull into needle slowly, inject into large muscle IM (deltoid, thighs) Step 3: nasal ○ Peel package open ○ Place thumb on both sides of plunger ○ Press plunger firmly into nostril ○ After 2-3 mins no response, give another dose ○ No priming needed Step 4: CPR ○ Place person in recovery position Hand supports head Knee stops body from rolling onto stomach ○ Push hard and fast in center of chest (compressions) until EMS arrive Aftercare & Withdrawal Likely uncomfortable but short-lived and not life-threatening Person may be angry or irritable, this is normal after waking up Remain calm and make the environment more comfortable (reduce bright lights, excess noise, additional bystanders) Nausea/vomiting, diarrhea, muscle aches, and sweating may occur Who should I offer a naloxone kit to? Patients on methadone and suboxone Patients on high dose opioids  Patients taking opioids for the first time Patients taking benzodiazepines, sedatives or gabapentin along with opioids Ideally, all patients on opioids should be offered a kit  PHYSIOTHERAPY Precision Physiotherapy A leading provider of physiotherapy services in Ontario. Specializes in personalized care, including: Pain management Rehabilitation Mobility improvement Preventative care Common Physiotherapy Devices and Their Uses These devices are often incorporated into physiotherapy sessions to enhance recovery and therapeutic outcomes: TENS Machine (Transcutaneous Electrical Nerve Stimulation): ○ Purpose: Pain relief through electrical nerve stimulation. ○ Usage: Helps reduce acute and chronic pain by blocking pain signals to the brain. ○ Availability: May be rented or purchased with support from insurance or programs like the Ontario Assistive Devices Program (ADP). Ultrasound Therapy Devices: ○ Purpose: Use of sound waves to penetrate deep tissues for pain relief, reduced swelling, and tissue repair. ○ Common Uses: Soft tissue injuries, muscle tightness, and inflammation. Electrotherapy Devices: ○ Purpose: Stimulate muscles and nerves for improved function, pain reduction, and recovery. ○ Application: Often used for nerve pain, muscle spasms, or rehabilitation post-injury. Hot and Cold Therapy Units: ○ Heat: Improves blood flow and relaxes muscles. ○ Cold: Reduces swelling and inflammation. ○ Devices: Heating pads, gel packs, and cryotherapy machines. Compression Therapy Devices: Rehabilitation Equipment: ○ Examples: Resistance bands, balance boards, and foam rollers for guided exercises to rebuild strength and mobility. Insurance and Coverage in Ontario Ontario Health Insurance Plan (OHIP): Typically does not cover devices but may cover physiotherapy sessions in certain cases (e.g., low-income seniors or hospital-based treatments). Private Insurance: Often covers physiotherapy sessions and partially reimburses for device purchases. Assistive Devices Program (ADP): May provide financial assistance for certain physiotherapy-related equipment if medically necessary.