(7) Home Medical Equipment and Ostomy Care

Topics we cover?

• Ostomy Care

• Home Test Basics

• Specific Home Tests

Ostomy Care - topics covered

• Healthy stoma + when to refer

• Ostomy types

• Ostomy concerns

  • Fluid/electrolyte concerns/Diarreha

  • Constipation

• Medication considerations

  • Med Forumations

  • Med Effects

  • Med Color Changes

OSTOMY CARE

Healthy Stoma

• Healthy stoma = pink/red + moist

• Any change in appearance → REFER

OSTOMY CARE

Types of Ostomy

• Colostomy → colon / large intestine

• Ileostomy → ileum / end of small intestine

• Urinary ostomy → alternate route for urine

OSTOMY CARE

Ostomy concerns

• Biggest Ostomy Concern: ↑ fluid/electrolyte loss (Diarrhea) → ↑ dehydration risk

  • Good hydration is important, especially during illness.

• Constipation

  • NOT recommend OTC laxatives for self-care unless provider supervised.

OSTOMY CARE - Medication considerations

Med Forumations

AVOID:

• Extended-release / sustained-release

• Enteric-coated medications

WHY?

• Shorter GI tract

  • → less time for drug to dissolve/release

  • → ↓ absorption / effectiveness

OSTOMY CARE - Medication considerations

Medication Effects

• Meds that cause Diarrhea

  • Magnesium

  • Antibiotics ( fungal overgrowth concern)

• Meds that ↑ fluid/electrolyte loss:

  • Diuretics

  • Laxatives (avoid unsupervised self-care)

• Meds that Constipation

  • Calcium

  • Aluminum

  • Opioids (↓ GI motility)

OSTOMY CARE - Medication considerations

Medication Color Changes

• Medication can change stool/urine color → patient may mistake it for blood.

  • Iron → dark/greenish-black stool

  • Bismuth → black stool

  • Rifampin → orange/red body fluids

Home Test Basics - topics discussed

• False positive vs false negative

• Sensitivity vs specificity

• General test rules

Home Test Basics

False Positive vs False Negative

• False positive

  • test positive, but patient does NOT have disease = false alarm

• False negative

  • Test negative, but patient DOES have disease = missed disease

Home Test Basics

 Sensitivity vs Specificity

• Sensitivity

  • Ability to correctly identify people WHO HAVE the condition

  • High sensitivity → few false negatives

  • Example:

    • 90% sensitivity

      • → of 100 people who truly have disease

      • → 90 test positive

• Specificity

  • Ability to correctly identify people WITHOUT the condition

  • High specificity → few false positives

 

Home Test Basics

 General Home-Test Rule

• For ANY home test, think:

  • Result + symptoms + timing + interferences

• Know:

  • Follow directions

  • Check expiration

  • Follow exact timing

  • Consider medications/foods/conditions that interfere

• Most important:

  • Negative ≠ automatically disease-free

    Positive ≠ automatically confirmed diagnosis

Specific Home Tests - overview

• Fecal Occult Blood Test (FOBT)

• UTI testing

• COVID/flu

• Hepatitis C

• HIV

• STI tests

• Home Drug Tests

Specific Home Tests

Fecal Occult Blood Test (FOBT)

• FOBT = blood in stool detector, NOT cancer detector

• Positive → follow-up

• negative with a polyp and positive without cancer

Specific Home Tests

UTI

• Nitrate: Not all urinary pathogens produce nitrate. Therefore:

  • Negative nitrite ≠ no UTI

• Leukocyte esterase - Marker of white blood cells / urinary inflammation

  • Negative leukocyte esterase

    • → UTI less likely, but does not completely rule it out

Specific Home Tests

COVID / Flu

• Detects antigens.

• Main rule:

  • Negative antigen test does NOT always rule out infection.

  • Why? Testing too early → not enough antigen detectable yet.

Specific Home Tests

HIV

• Detects: HIV-1/HIV-2 antibodies

• Testing too early → false negative possible. Wait 90 days more reliable

  • Antibodies take time to develop.

  • Exposure

    • → antibodies develop

    • → eventually become detectable

• Also know:

  • PrEP/antivirals → may affect home-test accuracy/refer

  • Positive home test → needs confirmation

Specific Home Tests

 Hepatitis C

• Detects: Hepatitis C antibodies

• Antibody positive cannot distinguish: past/resolved infection vs current active infection

• Positive Hep C antibody → RNA/viral load → determines current active infection.

• Testing too early

  → antibody may not be detectable

  → false negative possible

Specific Home Tests

STI

• Home tests exist for some STIs

• They do not cover every STI

• Negative test may miss recent infection (false negative)

• Positive → confirmation + referral/treatment

Specific Home Tests

HOME DRUG TESTS

• Screening only

• Positive result → confirm with more specific lab test

• Cross-reactivity → false positives can occur