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Getting Ready for Certification

Getting Ready for Ostomy Certification

Assessing and Managing the Colostomy

Wogoman, Cathy

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Journal of Wound, Ostomy and Continence Nursing: January/February 2021 - Volume 48 - Issue 1 - p 83-85
doi: 10.1097/WON.0000000000000722
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The COCN (Certified Ostomy Care Nurse) and the COCN-AP (Certified Ostomy Care Nurse–Advanced Practice) play a vital role in the life of the patient living with a colostomy. From the initial marking of the potential stoma site to the selection of the best products for the patient, the COCN and the COCN-AP are essential resources for information and education as well as improving quality of life. According to recent statistics, there are between 725,000 and 1 million people in the United States alone with some type of ostomy, with the majority of those numbers being colostomies or ileostomies.1 The role of the COCN and the COCN-AP can make a substantial impact in the life of the new ostomate. Starting with their initial vital role of marking the ostomy site to the continued care throughout the lifetime of the ostomate, the COCN and the COCN-AP provide much needed support, encouragement, and education to the patient living with an ostomy.2

The new ostomate faces many challenges such as daily care of the ostomy, dietary considerations, odor management, and acceptance. The COCN and the COCN-AP possess the necessary training and education to assist the new ostomate to successfully overcome these new challenges. The assessment of the newly created stoma site by the COCN and the COCN-AP will include stoma measurement, peristomal skin assessment, and inspection. Reassurance is given to the new ostomate, providing the opportunity for questions as well as addressing any issues that have occurred since the surgery. This is also a good time to provide education on how to access accurate information and find related support groups, as well as provide important resources and numbers to call for assistance.

The COCN and the COCN-AP are vital to the ostomate not only at the beginning of his or her journey but also throughout his or her lifetime. The ostomy may change in size, the ostomate's activity may increase or decrease, skin complications may arise, and changes in the health condition may dictate either a new way of performing care or changing to a different pouching system. The COCN and the COCN-AP can provide the knowledge and assistance to aid the ostomate during these periods of transition.

Providing education is another important role of the COCN and the COCN-AP throughout the lifetime of the ostomate. A few of the important factors for education include how and when to change the wafer, cleaning and preparing the peristoma skin, dealing with skin issues, disposal of products, managing odor, sexuality, how to prepare an emergency kit, and showering.3 The patient should also be educated on potential complications that may arise and how to problem solve. It is also important to educate a family member, significant other, or friend who can assist with the ostomy in case the ostomate is incapacitated at some point and unable to care for his or her own ostomy.

One has only to read the testimonials to realize the major role the COCN and the COCN-AP play in the life of the ostomate.4 Becoming a WOCNCB-certified COCN or COCN-AP is a rewarding career move that makes a tremendous impact on the life of the ostomate.

    PRACTICE QUESTIONS

    COCN Review Questions

    1. You are seeing a patient with a colostomy and his caregiver for the first time in the outpatient clinic after his colostomy. The caregiver addresses all questions you ask regarding care. You discover that the caregiver has been performing all the ostomy care since discharge. The caregiver states, “He won't even look at it.” The patient responds by stating, “I don't think I can ever deal with this.” What is your best initial intervention?

    1. Refer the patient to a mental health counselor.
    2. Assure the patient that most all ostomates feel the same way initially.
    3. Further investigate the patient's concerns.
    4. Allow the caregiver to continue providing care for now and deal with the issue at a later time when the patient is ready.

    Content outline: Domain 1, Task 3, 010301

    Cognitive level: Application

    Answer C:

    Rationale: The correct answer is to further investigate the patient's concerns. To best assist the patient, you must gain an understanding of why the patient feels he cannot deal with the situation. Once you have discovered the reasoning, you can assist the patient with the issues at hand. Referring the patient to a mental health counselor may be a solution, but you must first assess the need for this referral. Assuring the patient that most ostomates feel the same way may provide some comfort to the patient but does not address his expressed issues. Although allowing the caregiver to continue providing care until the patient is ready could be a viable part of the plan of care, it does not provide a solution to the problem the patient is having with being unable to even visualize the ostomy. You might have the caregiver continue giving care but have the patient become an active participant in care such as cutting the wafer or handing the caregiver the supplies.

      2. A teenage female patient with a colostomy whom you have been seeing for 2 years comes to your clinic per her mother's request. The mother states that her daughter has become distant and avoids letting her mother help with her care or even look at her ostomy. Her mother is concerned that her daughter is having issues with depression. Choose the next best course of action.

      1. Perform a depression assessment of the patient.
      2. Gather further assessment information from the mother.
      3. Assess the patient with the mother in the room to reassure her that everything is going well with her daughter's ostomy.
      4. Speak with the patient separately to discuss her concerns.

      Content outline: Domain 1, Task 3, 010302

      Cognitive level: Evaluation

      Answer D:

      Rationale: The correct action is to speak with the patient separately to discuss her concerns. According to Erikson's Eight Stages of Development, adolescents can develop poor body image and are often very self-conscious about their bodies. Talking to the patient alone allows her the ability to express these concerns. Although depression could play a part in the patient's withdrawal, it is best to speak with her privately to determine if depression is a factor. Asking only the mother questions does not address the daughter's issues and does not allow her to be an active participant in her plan of care. Because the daughter is already having an issue with her mother viewing her ostomy, performing an assessment in front of her mother could further complicate the situation.

        3. You are performing initial teaching with a patient who has just returned from her colostomy surgery. Identify the most appropriate goal for this patient to be completed prior to discharge.

        1. Independent emptying of the pouch
        2. Irrigation technique
        3. Caregiver demonstration of wafer preparation
        4. Accurate identification of peristomal complications

        Content outline: Domain 1, Task 3, 010303

        Cognitive level: Knowledge

        Answer A:

        Rationale: The patient should be independent in the emptying of the pouch as this is an essential basic technique. This is an appropriate goal for the patient prior to discharge. Although the identification of peristomal conditions is important for the new ostomate, knowing how to take care of the ostomy and the pouching system would be a more pressing goal at this stage. Caregiver demonstration, although also important, would not be a patient-centered goal.

          COCN-AP Review Question

          4. You are seeing a patient in the ostomy clinic for an initial assessment. The patient is complaining of bleeding from the peristomal skin with an area of dark blue discoloration that the patient states has been present for 3 months. He has been using the same pouching system and technique for 5 years since his initial surgery. What diagnostic test wound you recommend for this patient?

          1. Complete blood cell (CBC) count
          2. Biopsy
          3. MRI
          4. Skin scraping

          Content outline: Domain AP Ostomy 1C Comprehensive Assessment

          Cognitive level: Analysis

          Answer B:

          Rationale: Since the patient reports a new skin lesion with bleeding, the best diagnostic test would be a biopsy. Although skin cancer is rare at the stomal site, it is not without occurrence. The CWOCN-AP would want to obtain a thorough history of the ostomy, family history of cancer to include skin cancers, and patient history of cancer. A CBC count and MRI would only be relevant initially but may be utilized for more intensive workup. The skin scraping would only be indicated if the diagnosis were more indicative of a fungal or bacterial infection.

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