Case Study 34.4

Julie is 5 days post colectomy with ileostomy (subtotal). She has had an uneventful recovery and the consultant would like to discharge Julie home in the next 2 days.

Devise a discharge plan for Julie including:

A health education plan to teach Julie about how to change her stoma bag (think about the skills you will use when teaching her)

  • Talk through procedure of changing stoma as you do it. Explain to Julie what you are doing and why.
  • At first demonstrate each step of the skill then allow Julie to do it under your guidance.
  • Show equipment, i.e. stoma bags
  • How to prepare stoma bag and phalange to be placed on skin
  • Clean skin with warm water and a soft cloth
  • Use skin preparation if advised by stoma nurse
  • Apply phalange and bag

Follow up appointments, with whom

  • Consultant
  • Stoma nurse

Community support

  • Stoma nurse
  • District nurse
  • GP
  • Pharmacist
  • What products you would need to organise for Julie to take home with her 
  • Phalanges
  • Stoma bags
  • Specific skin sprays or creams
  • Stoma kit

Information on where to get further ostomy supplies from

  • Stoma nurse
  • Pharmacist

Showering or bathing

  • To shower rather than bath as in a bath you soak and wound can go soft

Skin care

  • Keep skin around site clean and dry
  • Make sure the phalange is cut to correct size to prevent leakage on to skin
  • Use specific creams or spray to protect the skin

Sexual relations

  • To recommence when she feels able to
  • Ensure bag empty so is does not fall off

Wound care and removal of sutures

  • Observe wound for redness or opening up
  • Keep dry and clean; maybe send dry dressings home
  • Ensure clothes not rubbing on site
  • District nurse referral to check wound
  • Sutures to be removed at approx. 10/12 days by district nurse or at GP