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.
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
 CASE STUDY

PMH: T2DM, HTN, osteoarthritis Glucose 163 (70-99)

HgbA1C 6.5 ( <5.7)
Tobacco/alcohol: none
T chol 235 ( <200)
FamHx: T2DM, HTN; mother
LDL 149 ( <130)
BP: 130/89 Hemoglobin 10.7 (12-16)
Weight : 165 lbs UBW: 175lbs Hematocrit 34 (37-47)

Dx: adenocarcinoma of the colon stage IIA

Height Weight Idea Body BMI % Weight
Medical treatment plan: NPO with ice chips, IV, Weight Lost

oral pain meds, consults for oncology, nutrition, 54 165 120 28.3 6%
and stoma care.
 POSTOPERATIVE NUTRITION CARE

After surgery, depending on hospitals 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.
FACTORS FOR BBS 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 54.5 x 30 = 1635kcal ; 54.5 x 40 = 2180kcal

30-40kcal/kg

1635 - 2180 kcal/day

Protein needs 54.5 x 1.5 = 81.75 kcal; 54.5 x 2 = 109g

1.5-2g/kg

81.7 109 g/day

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

Intervention Monitoring
Short term goal Oral fluid intake
Promote healing of resected bowel and the stoma
Total energy intake
Identifying offending foods
Understand the impact of the disease on health and Evaluation
nutrition modifications.
keep records of what BB eats and her symptoms
Long term goal
Assess the patient's skin surrounding the stoma
Excess fluid output
Fiber intake See patient biweekly with some blood work to
Prevent blockage see if her glucose, A1C, LDL, hemoglobin has
Short term goal: promote healing of resected bowel decreased.
and the stoma
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). Krauses food & the nutrition
care process (Krauses food & nutrition therapy) (13th ed.). Philadelphia, PA, United States:
Elsevier Health Sciences.
Lecture Note