ostomy By Grace boamah

What is an Ostomy? A surgical procedure performed when normal bowel or bladder function is lost due to birth defects, treatment for diseases such as cancer, or injury. Types of ostomies Colostomy: A colostomy is a surgical procedure that brings a portion of the large intestine through the abdominal wall to carry feces out of the body. Ileostomy: A surgery creating an opening in the abdomen and pulling through a portion of the small intestine to create a stoma. Conditions that may require an ostomy include colorectal cancer, traumatic injury to the bowel or bladder, diverticulitis, inflammatory bowel disease, and removal of the bladder. An ostomy may be temporary or permanent. Temporary ostomies are created when the digestive tract myst be allowed to heal without irritation caused by the passage of waste.

Summary of my case study BB is a 61 year old female with increasing abdominal pain Determined to have an intestinal obstruction, underwent immediate surgery resulting in partial colectomy and creation of colostomy. Eating Habits - Watches intake of salt and carbohydrate - She does not cook - Frequently eats out BB is a 61 year old female with increasing abdominal pain secondary to mass in ascending colon. Determined to have an intestinal obstruction, underwent immediate surgery resulting in partial colectomy and creation of colostomy. She is divorced, has no children, speaks English and has a master’s degree (employed as a respiratory therapist). Patient states that her eating habits have not really changed over the past year—she tries to watch the amount of salt and carbohydrate in her diet. She lives by herself so she does not cook often as she would like. Generally eats out for lunch at work and picks something up on her way home for dinner

Case study PMH: T2DM, HTN, osteoarthritis Tobacco/alcohol: none FamHx: T2DM, HTN; mother BP: 130/89 Weight : 165 lbs UBW: 175lbs Dx: adenocarcinoma of the colon stage IIA Medical treatment plan: NPO with ice chips, IV, oral pain meds, consults for oncology, nutrition, and stoma care. Glucose 163  (70-99) HgbA1C 6.5  ( <5.7) T chol 235  ( <200) LDL 149  ( <130) Hemoglobin 10.7  (12-16) Hematocrit 34  (37-47) Patient lab result are higher than the normal value Her blood pressure is higher than normal range Height Weight Idea Body Weight BMI % Weight Lost 5’4” 165 120  28.3 6%

postoperative nutrition care After surgery, depending on hospital’s postop protocol, patient may start eating on day one Eating plan begins with clear liquids and should be advanced to soft and low fiber diet as tolerated. Remember to chew slowly, drink fluids as instructed, monitor food intolerances (stool changes, flatulence), and gradually increase fiber to reduce risk of obstruction. Return to regular diet within 6 to 8 weeks after surgery . The location of the stomach is a factor in the fluid intake. After surgery, your bowel is swollen and you should avoid high fiber foods. This is because they are harder to digest and avoiding them will allow the bowel to heal and to avoid blockage of the colostomy. Eating plan begins with clear liquids and then should be advanced to a fiber restricted diet before living the hospital. Always chew food slowly and well to help reduce the risk of blockage of the ostomy

Factors for BB’s nutrition planning Type of surgery influences her nutrition status Stoma at ascending colon is rare More fluid and digestive enzymes in colon Stoma healing is more difficult

Anthropometric measures Energy needs 30-40kcal/kg 54.5 x 30 = 1635kcal ; 54.5 x 40 = 2180kcal 1635 - 2180 kcal/day Protein needs 1.5-2g/kg 54.5 x 1.5 = 81.75 kcal; 54.5 x 2 = 109g 81.7 – 109 g/day Energy needs for patients 30-40kcal/kg; 1.5-2g/kg

PES Statement Increase protein needs (NI-5.1) related to total colectomy as evidenced by increase postop nutrient needs. Altered Gl function (NC-1.4) related to partial colectomy and creation of colostomy as evidenced by surgery. Increased nutrient needs (NI-5.1) rated to GI surgery, partial colectomy with colostomy creation as evidenced by ostomy

nutrition care plan Monitoring Oral fluid intake Total energy intake Intervention Short term goal Promote healing of resected bowel and the stoma Identifying offending foods Understand the impact of the disease on health and nutrition modifications. Long term goal Excess fluid output Fiber intake Prevent blockage Short term goal: promote healing of resected bowel and the stoma Monitoring Oral fluid intake Total energy intake Evaluation keep records of what BB eats and her symptoms Assess the patient's skin surrounding the stoma See patient biweekly with some blood work to see if her glucose, A1C, LDL, hemoglobin has decreased. Note: look for redness, excoriation or a break in skin integrity.

foods Loose stool or diarrhea: apple juice, prune juice, dried beans, raw fruit and vegetable, fried, green leafy Foods that thicken: applesauce, mushroom, rice, pasta, tapioca, yogurt Odor: fish, eggs, garlic Gas: beans, broccoli, corn, spinach, cabbage, brussels sprouts

References Landmann, R. (2015, May 20). Routine care of patients with an ileostomy or colostomy and management of ostomy complications. Retrieved November 29, 2016, from UpToDate, https://www.uptodate.com/contents/routine-care-of-patients-with-an-ileostomy-or- colostomy-and-management-of-ostomy- complications?source=search_result&search=ostomy&selectedTitle=2~71 Mahan, K. L., Escott-Stump, S., Raymond, J. L., L. Kathleen Mahan MS RD CDE, Sylvia Escott- Stump MA RD LDN, & Janice L Raymond MS RD CD (2011). Krause’s food & the nutrition care process (Krause’s food & nutrition therapy) (13th ed.). Philadelphia, PA, United States: Elsevier Health Sciences. Lecture Note