Authors

Antonio Fernández-Gálvez1, Esperanza Macarena Espejo Lunar2

Position

1Máster Universitario Oficial en Nuevas Tendencias Asistenciales en Ciencias de la Salud. Unidad de Gestión Clínica de Cirugía General y Digestiva. Hospital Universitario Virgen del Rocío. Departamento de Enfermería. Facultad de Enfermería, Fisioterapia y Podología. Universidad de Sevilla (España)2Máster de Enfermería en Práctica Avanzada en cuidados a personas con ostomías. Unidad de Gestión Clínica de Cirugía General y Digestiva. Hospital Universitario Virgen del Rocío. Sevilla (España)

Contact address

Antonio José Fernández Gálvez. C/ Afrodita, 6. 41014 Sevilla (España).

Contact email: antoniogalvez_2@hotmail.com

Abstract

Enteroatmospheric fistula (EAF) is a non-natural communication between the gastrointestinal tract and the skin or atmosphere. We present the clinical case of a 58-year-old male with EAF and septic shock secondary to peritonitis, with a past history of multiple surgical interventions due to relapsed abdominal eventration, bowel perforation, and epigastric hernia. At his arrival at the Catastrophic Abdomen Unit of Reference for Andalusia (Spain), there was assessment according to Marjory Gordon’s Functional Health Patterns, and the following were noticed: Type 2 bowel failure, sarcopenia, open abdomen with complete loss of the abdominal wall, lack of knowledge about his health problem, and severe dependence. A plan of care was designed according to the NANDA-NOC-NIC taxonomy for the diagnoses: “Impaired skin integrity”, “Deficient knowledge”, and “Self-care deficit for bathing/dressing/toileting”. NOC objectives were determined focused on: “Tissue integrity”, “Ostomy care”, and “Self-care in bathing/hygiene/dressing/toileting”. The wound was cured through negative pressure therapy with floating stoma with a personalized 3D-printed biomaterial prosthesis (Astarté). At hospital discharge (after seven months), all indicators had significantly increased their basal score by 3-4 points; the conclusion was that a holistic plan of care conducted by an interdisciplinary team and implemented alongside innovative and effective techniques for EAF care was highly effective.

Keywords:

Intestinal fistula; enteroatmospheric fistula; negative-pressure wound therapy; astarté prosthesis; ostomy; stomatherapist; standardized nursing terminology; patient care planningMarjory Gordon’s Functional Health Patterns

Versión en Español

Título:

Manejo del paciente con fístula enteroatmosférica: plan de cuidados individualizado