Skin care
Maintaining healthy skin is particularly important for
people with rheumatoid arthritis, as any skin damage caused
by steroid medication and the inflammatory response will
take longer to heal (Black, 2000; Vickers, 2004; Lowther,
2012). Tap turners may help the patient with stiff, painful
hands, and if he or she cannot access the bathroom then
water could be put in a bowl or flask for use later. Any
wet wipes used should be non-perfumed, in suitable-sized
pieces and in an easy-to-access pack. A family member or
carer could cut up or tear dry wipes ready for use. If the
person has difficulty drying their skin, folded kitchen roll
held over the stoma for a few moments, or a small towel
kept solely for that purpose, may be an alternative.
Removing and fitting the pouch
Reduced dexterity can make it difficult to get hold of the
edge of the adhesive in order to remove the pouch. Most
appliances have a tab to aid this, but if the patient uses a
product with an adhesive border, leaving a small piece of the
paper backing on a side strip may also allow easier grip.
Removing the backing from the adhesive can also be a
challenge. A larger tab, or folding the tab to spring it away
from the adhesive, may be considered.
Stiffness or pain in the neck may prevent a person with
arthritis looking down. Taking medication before a pouch
change, improving lighting and the use of a magnifying
mirror may aid visibility. People can be advised to fold the
pouch away from the body so that it can be positioned
just below the stoma, then the rest of the adhesive lifted
up. Touching to explore the stoma site can help identify
landmarks for fitting. Warming the pouch gains flexibility
and promotes quicker adhesion and using the back of the
hand or arm to ‘smooth’ the pouch adhesive to ensure
adhesion may also help.