Individualize Product Selection: Living
with Your Ostomy
•PMH/PSH
•Sensory
and manual dexterity
•Education/Cognition
•Occupation
•Finances
•Living
arrangements
•Social
support
•Pain
•Recreation/Activity
tolerance
•Nutrition/hydration
A comprehensive assessment should include both the
patient and their stoma.
Both are essential in order to maximize their self-care
skills and confidence in adjusting to their new life
with an ostomy. No one size, type or brand of appliance
will fit everyone. As with any patient, a thorough
assessment must be made prior to ostomy surgery. The
assessment should be done with the knowledge of why the
patient needs ostomy surgery (Cancer—that could require
additional treatment--or Inflammatory Bowel Disease
where the removal of the diseased colon will alleviate
the need for further medical treatment). Pertinent past
medical history or (PMH) and past surgical history or (PSH)
is also important, as are the patient’s education level,
level of cognition, and their mental status. Also, their
occupation can play a significant role in their ability
to successfully live with an ostomy. Other
considerations should include financial and insurance
resources, as well as a physical assessment of the
patient that includes checking their vision, hearing,
and manual dexterity for any potential issues.
Some of the assessment should also include personal
factors such as whether they have any social support at
home, and what their access to toilet facilities are
like at work and home. Whether they have pain or an
activity tolerance can influence decisions regarding
product selection. Their prior recreational activities
are also helpful to know (for instance, a patient in
their 70’s with a new ileostomy may have been attending
water aerobics classes four days per week for the past
ten years—and will probably want to continue). This
needs to be taken into consideration. And, of course,
their nutrition and hydration status, and current height
and weight versus optimal.
•Stoma
type and location
•Size/shape/height
•Lumen
location
•Effluent
characteristics
•Peristomal
skin condition
•Abdomen
characteristics
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There are several assessment considerations for stomas
including the following:
The stoma’s type (large bowel/ small bowel) (end, loop or
double-barrel),
and its location on the abdomen--for instance, right lower
quadrant or left lower quadrant.
The size, shape and height of stoma.
The location of the stoma lumen (straight up or on the
side).
And the effluent: is it urine or stool, in what amounts,
what consistency, and is there any recognizable timing as to
when it becomes more “active”.
Also consider the peristomal skin condition: is it intact or
impaired?
And the characteristics of the abdomen: are there old scars,
surgical incisions, dimpling, skin folds or flabbiness?
And when the patient sits, stands or lays down, is there any
change in the way the stoma looks—or its position?
Medicare
Coverage Amounts
Examples per month
•Ostomy
pouch, drainable 2 piece - 20
•Ostomy
skin barrier with flange - 20
•Closed
end bag - 60
•Ostomy
Belt - 1/month
•Paste
- 2
•Overnight
drainage bag - 2
(quantities in excess of guideline needs to be explained
in writing to the fiscal intermediary)