Encourage the patient to verbalize fears and clarify the physician's explanation of diagnostic results. Dispel any misconceptions about the need for a permanent colostomy, and clarify the purpose of a temporary colostomy, if suggested.

244 Colorectal Cancer

If a colostomy is to be performed, encourage the patient and her or his significant other to verbalize concerns about sexual functioning after surgery. Impotence is only a problem after abdominal perineal resection (APR) in men, but the presence of a stoma and a drainage pouch with fecal effluent can affect self-identity and sexual desires in both men and women.

After surgery, discuss methods to decrease the impact of the ostomy during intimate times. After surgery, help the patient avoid complications associated with bowel surgery. Assist the patient to turn in bed and perform coughing, deep-breathing, and leg exercises every 2 hours to prevent skin breakdown, as well as to avoid pulmonary and vascular stasis. Teach the patient to splint the abdominal incision with a pillow to minimize pain when turning or performing coughing and deep-breathing exercises. The patient who has had an APR may find the side-lying position in bed the most comfortable. Provide a soft or "waffle" pillow (not a rubber doughnut) for use in the sitting position. Change the perineal dressing frequently to prevent irritation to the surrounding skin.

Showing the patient pictures of an actual stoma can help reduce the "shock" of seeing the stoma for the first time. Allow him or her to hold the equipment, observe the amount and characteristics of effluent, and empty the ostomy pouch of contents or gas. Take care when emptying or changing the pouch system not to contaminate the abdominal incision with effluent. Teaching the patient about home care of an ostomy can begin on the second or third postoperative day. Have the patient and a family member demonstrate ostomy care correctly before hospital discharge. Be alert to signs that indicate the need for counseling, and suggest a referral if the patient is not adjusting well.

Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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