Patient Name: Mr Harvey
Nurse Name: Helen Coulter
Patient Care Setting: Community NI
Patient Overview: 67-year-old – Male – Hartmanns colostomy (2018) following bowel cancer. Very active, lives alone, manages stoma independently.
Problem: Developed a full thickness parastomal ulcer at the 2-4 o’clock position, ulcer was clean and bleeding easily, there was no slough present, it was painful when touched, the remainder of his peristomal area had slight discolouration but was not painful.
Has been wearing a firm convex pouch and a support garment.
Suspected Cause: I felt this was a pressure ulcer caused by combined pressure from the firm flange convexity and the support garment.
Course of treatment: I dressed the ulcer with Aquacal AG and duoderm topically to hold it in place.
I changed him onto a flat baseplate (Pelican 2 Piece system) to reduce the peristomal pressure and asked him to change the baseplate every 48 hours. I resized his stoma and increased the pouch aperture slightly as he had been cutting his own aperture as his previous supplier did not provide this service for him.
Interventions/complications? No complications were encountered, on phone review after 2 days he felt the ulcer was smaller, not so pain
ful or bleeding so freely, he found he was able to redress it himself without any problems.
Outcome: I kept him under review and by 3/52 his ulcer was completely healed, he found the 2 piece Pelican system easy to use and decided to continue to use it as he found he was able to stoop without it being noticeable/uncomfortable and “digging in”. He happily wore the 2 piece and support garment together without any problems when at work.
Conclusions: His peristomal skin is now healthy and intact. He changes his baseplate every 3 days and his pouch twice a day, using his firm 1 piece convex pouch he was changing it 3-4 times a day to minimise discomfort, and occasionally would have left it off few a few hours in the evening time to “rest his skin” he finds he does not have to do that with the Pelican 2 piece system.
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