Author: Lydia Kruit, South Africa, Stomaltherapist.
This case study looks at how Eakin Wound Pouches can improve a cancer patient’s quality of life after a laparotomy wound dehisced shortly after surgery.
- Mr. Naude is a 57 year old white, afrikaans, medium built male from Stellenbosch, Cape Town, South Africa.
- He is married with 2 children in high school.
- He is a professional engineer at the CSIR Built Environment Stellenbosch.
- There is a family history of colon cancer and his father died of the illness in his mid fifties.
- Mr. Naude went for a colonoscopy every 2 years to a surgeon.
- He is a non drinker and a non smoker.
Patient’s Calendar of Events
|| Signs & Symptoms
|1 August 2007
||• Blood in his stool with every bowel action
• Bloated stomach
• Losing weight
• General malaise, not feeling well
• Constipation and diahorrea on and off
• Could not climb stairs as he was “JUST TOO TIRED”
|• Gastroscopy and colonoscopy – Normal
||• Patient was treated for iron deficiency|
|2 January 2008
||• Still has all of the symptoms as mentioned above.
||• Colonoscopy revealed no abnormalities
||• Treated for iron deficiency|
|3 March 2009
||• Still experiencing the same symptoms
|4 March 2009
• Petscan done
• Taking 2-3 photos of the small intestine every second – cost R10 000
• Scan took 7 hours to carry out
• No diagnosis made.
• SYMPTOMS GETTING WORSE!
|5 May 2009
||• Blood transfusion given|
|6 July 2009
||• Colonoscopy carried out with an EXTRA LONG SCOPE.
• Discovered a slow growing tumour just at the ceacum
• Mr. Naude’s colon is 30cm longer than the average person, therefore general scopes were too short for his colon examination.
|7 July 2009
||• Laparotomy and colectomy done discovering METASTISIES TO THE LIVER AND IN ALL THE SURROUNDING LYMPH NODES.
|8 August 2009
||• Patient started with aggressive chemotherapy with no effect.|
|9 Sept 2009
||• SERIOUS VOMITTING OCCURED AND PATIENT BROUGHT UP AN 8CM WHITE WORM.
|10 Sept 2009
||• Patient admitted for total small bowel obstruction.
• Laparotomy performed and obstruction is removed, but Dr warned that the cancer will continue to grow.
• Laparotomy wound dehisced and burst open in the ward.
|25 Sept 2009
||• Patient is discharged – for palliative care.|
Nursing care: Plan
- Pain relief needed - patient was already on Duragesic stickers in an attempt to relieve pain.
- Get the patient comfortable.
- Proper wound care specifically to protect surrounding skin, prevent leakage and prevent any odours.
- Allow mobilisation without leakage.
- Most importantly, to win the patients trust.
- Pouching the wound content as well as the stomal efflux.
- ALSO: general care and rehydration.
- Lots of support.
After a thorough assessment it was decided that the following treatment would be best:
- The wound was cleaned with normal saline and the edges were protected with:
Eakin Cohesive® Seals
Eakin Cohesive® Paste
Eakin Wound Pouches.
- The Wound Pouch was changed every 4-5 days.
- Woundbed tissue was red and fragile.
- No infection was diagnosed on the wound.
- Moisture: drained over 67% ++++
- The Eakin Wound Pouch made a huge difference in managing the huge amount of severely acidic exudate which was yellow pus, green stool, and blood most of the time.
- Thanks to the Eakin Cohesive® skin protector placed around the entire wound at each pouch change, the wound was almost fully healed within just 3 months!
- The odour was gone, occluded in the bag.
- The patient was comfortable and the family were happy.
Fig 3Fig 2Fig 1
Fig 6Fig 5Fig 4
Fig 7: After 3 months
- The fact that Eakin products were available and were used in the palliative comfort of the patient, made it possible for me, as a Stomaltherapist, to give the patient the most comfortable, pain-free, leak-free, odour-free and lastly worry-free quality time with his family.
- The patient’s overall physical condition is a factor in determining the risk of the procedures and the individual’s ability to accept it. This patient experienced a positive result through the use of the Eakin products and the aftercare he received.
- Mr. Naude was able to resume some of his computer work and was creating his own website with family and friends.