1. ostomy
By Grace boamah

2. 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.

3. 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

4. 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
 (70-99)
HgbA1C
 ( <5.7)
T chol
 ( <200)
LDL
 ( <130)
Hemoglobin
 (12-16)
Hematocrit
 (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%

5. 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

6. 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

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

8. 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

9. 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.

10. 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

11. 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, 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