Chapter 11 Ostomy Care
11.2 Ostomy Care
Critical Thinking Exercises: Questions, Answers, and Sources / References
- What dietary or medication changes might be considered for a patient who has a new ileostomy and no longer has a small bowel? Answer:
Changes to nutritional requirements will depend on the type of ostomy. Here are some general guidelines for anyone with an ostomy:
- Gradually introduce foods following a new ostomy. Gut function has been interrupted and needs time to adjust. Add new foods gradually to your diet to determine their effect on your ostomy management
- Drink 6-8 glasses of water daily. People with ileostomies may have to increase fluid intake further to offset fluid losses (ileostomy output is normally liquid)
- Nutritional needs will vary based on the part of the bowel the patient is left with. Generally people with ileostomies have to be careful with fiber. Too much fibre can cause bowel obstruction.
- Dietary changes from pre op may be minor if at all. The patient will have to experiment and evaluate how their body handles foods.
- Eat a regular balanced diet that includes the necessary vitamins, minerals and calories needed for good health
Sources:
Alberta Health Services. (2013). Eating Well after Ostomy Surgery. https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-eating-well-after-ostomy-surgery.pdf
Government of Australia (2013). Healthy eating with an ileostomy. Retrieved https://www.health.qld.gov.au/__data/assets/pdf_file/0026/152558/gastro_ileostomy.pdf
Pasia, M. , (2017) Ostomy Nutrition Guide. United Ostomy Associations of America. https://www.ostomy.org/wp-content/uploads/2018/01/OstomyNutritionGuide.pdf
2. A patient with a new colostomy refuses to look at their stoma or participate in changing the pouching system. What are some suggestions to help your patient adjust to the stoma?
Answer: recognize that this change in body image is accompanied by a physical and psychological / emotional response. Validate the patient’s feelings. Consider interprofessional support to help with the psycho / emotional healing. Begin teaching the mechanics of ostomy care by using clean equipment and encourage the patient to manipulate the equipment. Ensure home nursing care / follow up care is arranged prior to discharge. Investigate other community resources including support people to be involved with care.
- Identify key differences between an ileostomy , colostomy and urostomy (answer Yes or No)
| Characteristic | Answer | More information |
| Colostomy output is characterized by liquid stool | No | Once healed, colostomies may produce regular formed bowel movements depending on how much large colon is being bypassed. Ileostomies are characterized by loose stool because the large bowel – where water reabsorption occurs- is completely bypassed |
| Eating a high fibre diet with an ileostomy might be contraindicated. | Yes | Large amounts of fibre can actually cause an ileostomy occlusion. High fibre foods – bean