*321 Exam 4 Diet & Care For Pts With Ileostomy And Colostomy

Front 1

Instruct patients with ileostomy to eat what type of food during the initial period of adjustment to the ileostomy?

Back 1

Eat foods such as clear soups, cottage cheese, liver, lean meat, rice, tea, and coffee

Front 2

patients with ileostomy

Resume ingestion of ______ foods one at a time after ileostomy function has stabilized to allow tolerance of them to be evaluated.

Back 2

high-fiber

Front 3

Instruct patients with ileostomy to do what with new food?

Back 3

Try each new food three times before deciding that it cannot be tolerated.

Front 4

Instruct patients with ileostomy to avoid foods that could block the stoma, such as:

Back 4

corn, popcorn, celery, Chinese food, peanuts, coconut, and skins of raw fruits

Front 5

Instruct patients with ileostomy to drink how much water per day?

why?

Back 5

Drink six to eight glasses of water per day to guard against dehydration because the water-absorbing surface in the intestine is decreased.

Front 6

Instruct patients with ileostomy to ingest what in the summer or when heavy perspiration occurs?

Back 6

Ingest electrolyte replacement solutions, such as Gatorade

Front 7

Instruct patients with ileostomy to decrease what if the output is too liquid?

Back 7

Decrease the amount of dietary fiber

Front 8

Instruct patients with ileostomy to eat 3 things to thicken the stool?

Back 8

pasta, boiled rice, low fat cheese

Front 9

Instruct patients with ileostomy to add what to their diet if the ileostomy output is too dry?

Back 9

add salt to diet

Front 10

Instruct patients with a colostomy to:

eat what type of diet for 4-6 weeks after surgery

Back 10

low-residue

Front 11

Instruct patients with a colostomy to:

after a low residue diet after 4-6 months of surgery, progress to what type of diet

Back 11

high carb, high protein, general diet after the 4-6 period

Front 12

Instruct patients with a colostomy to add new foods how?

Back 12

one at a time to determine their effect.
-try each new food at least 3 times to determine their effect

Front 13

Instruct patients with a colostomy to:

Consider the effects of foods that cause constipation, such as:

5

Back 13

cheese
nuts
chocolate
corn
raisins

Front 14

Instruct patients with a colostomy to:

Consider the effects of laxative foods, such as:

Back 14

prunes
fresh fruits
broccoli
spinach
green beans
liver
highly spices foods
beer

Front 15

Instruct patients with a colostomy to:

Consider the effects of gas forming foods, such as:

Back 15

nuts
cabbage
sauerkraut
corn
cauliflower & broccoli
spinach
peas
beans
apples
avocados
watermelon
cucumbers
carbonated beverages

Front 16

Instruct patients with a colostomy to:

Consider the effects of odor causing foods, such as:

Back 16

alcohol (esp beer)
onion
beans
cabbage
turnips
asparagus
mushrooms
radishes
cucumbers
eggs
fish
spicy foods

Front 17

What is an ostomy?

Back 17

(an artificial opening in the abdominal wall and fecal material is eliminated through)

-can be temporary or permanent

Front 18

Ileostomy (is this created in the small or large intestine)

-what will the fecal output be?

Back 18

small intestine

-will always have liquid/loose fecal output

Front 19

Ileostomy
-will have a kock pouch, what is that?

Back 19

they make a reservoir with a nipple pouch, and insert a catheter to drain this reservoir every couple of hours. Only done if someone has an ileostomy

Front 20

Colostomy (is this created in the small or large intestine)

Back 20

large intestine
– can be done in the ascending, transverse, descending, or sigmoid colon.

Front 21

Colostomy
-if it is done in the ascending colon, what will the consistency of the fecal matter be?

Back 21

liquid

Front 22

Colostomy
-if it is done in the transverse colon, what will the consistency of the fecal matter be?

Back 22

mushy/pasty

Front 23

Colostomy
-if it is done in the descending colon, what will the consistency of the fecal matter be?

Back 23

stool is more solid

Front 24

Colostomy made in the sigmoid colon is unique. Why?

Back 24

they will not need a collection bag. they can defecate through the anus

Front 25

Colostomy
-end colostomy

Back 25

-there is nothing behind it, the colon has been removed, it is permanent
-you have no rectum because you removed it

Front 26

Colostomy
-end colostomy

most often done in what part of the lg intestine?
-this is constructed by doing what?

Back 26

-done in the descending or sigmoid colon when a colostomy is intended to be permanent
-this is constructed by severing the end of the proximal portion of the bowel and bringing it out through the abdominal wall

Front 27

Colostomy
-double barrel

what happens if a pt needs this?

Back 27

they removed the disease portion or they created an ostomy to let the bowel rest behind it and they will have one end that is on the abdominal surface (proximal end) and the distal end they will tuck into the abdominal wall.
-Usually done if someone is having a temporary ostomy

Front 28

Colostomy
-double barrel

how is this created?

Back 28

-created by dividing the bowel and bringing both the proximal and distal portions to the abdominal surface to create two stomas. The proximal stoma (closest to the pts head) acts as a functioning stoma and eliminates stool.
-The distal stoma (farthest from head) is considered nonfunctioning and it may secrete some mucous. May be called mucous fistula

Front 29

Colostomy
-Loop colostomy

how is this done?
what part of the lg intestine is this done on?

Back 29

-bring loop of bowel to the abdominal wall, make an incision, and they will put rubber plastic rods to be used to support the loop until the intestinal tissue adheres to the abdominal wall

-most often performed in the transverse colon

Front 30

Ostomy Care
•Preop – bowel prep with antibiotics

Back 30

(clear liquids and erythromycin and neomyacin which are 2 antibiotics that are not absorbed systemically, they decrease the bacteria in the GI tract, thus making a cleaner envt for when the ostomy is created)

Front 31

Ostomy Care

Postop
•Routine postop care for an Ileostomy

When will they have output?

Back 31

24-48 hrs after surgery flatus with little output
-then high output of dark green liquid 1000-1800 ml and eventually normal output of approximately 800 ml/day

Front 32

Ostomy Care

•Routine postop care for an Colostomy
-fecal output occurs when?

Back 32

with return of bowel sounds

Front 33

when listening for bowel sounds, where is the first place you will listen and hear them?

Back 33

RLQ because that is where the ileocecal valve is

Front 34

what is the best indicator to know that one has an active GI tract?

Back 34

if they are passing gas (flatus) NOT bowel sounds.. flatus is a better indicator than bowel sounds

Front 35

The stoma will start out larger and then shrink.
-how many weeks will it take for the stoma to shrink?

-when will the stoma be at its permanent size?

Back 35

3 weeks to shrink

3 months it will be at it's permanent size

Front 36

Odor control & ostomy
-empty bag when it is how full?

Back 36

1/3 full to prevent it from coming loose
-can use deodorizers (drops, tablets)

Front 37

Skin integrity with ostomy
-clean and dry well
-use skin barriers
-who is at highest risk of skin breakdown (ileostomy or colostomy)

Back 37

ileostomy is at more of a risk because the fecal matter is liquidy

Front 38

Stoma and ostomy
-cut an opening how big to ensure that the stoma tissue is not going to be constricted

Back 38

1/8 to 1/16 of an inch

Front 39

ostomy and bag change
-how often should you teach them to change their appliance?

Back 39

every 5-7 days

Front 40

Instruct them when to call the doctor

Back 40

-stenosis (change in stoma)
-bleeding
-persistent constipation or diarrhea
-dehydration

Front 41

Ileostomy
-they are prone to dehydration during summer months and wanter when it is dry out. instruct them to do what to prevent this

Back 41

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