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 – beans, celery, mangoes, corn) must be consumed in moderation |
| A colostomy appliance might last longer than an ileostomy appliance. | Yes | Generally speaking, ileostomies with their liquid effluent create weight on the flange which affects the adherence to the skin. Ileostomy and urostomy flanges should be changed every 5 days before the flange leaks |
| Urostomy drainage might be foul smelling | Yes | Urine flows past the ileal conduit which has mucous production and bacterial as part of its normal flora. The nurse must recognize that this is generallly not an infection. |
| Fluid intake of approximately 2 litres / day should be encouraged for most people with an ileostomy or urostomy | Yes | Ileostomies are characterized by loose stool = ++ fluid loss: Urostomies present increased risk of UTI because of the nature of the conduit and proximity to the ureters and kidneys. Fluid intake should be encouraged unless existing health conditions make it contraindicated (ie. heart failure, renal failure etc) |
2. Describe how changing a urostomy (aka ileal conduit) flange / pouch is different than a colostomy/ ileostomy flange and pouch.
| Consideration when changing a flange / pouch on a urostomy / ileal conduit | Explanation |
| Urine flows continually from a urostomy making it a little more challenging to ensure a good seal with the flange.
|
Because the kidneys continually produce urine, a urostomy continually drips urine. Wet peristomal skin interferes with flange adhesion. Solution: Place a sterile guaze on top of the stoma to absorb urine during cleansing of peristomal skin and flange preparation. Remove it immediately before application of the new flange before urine can wet the peristomal skin. |
| Ureteral Stents that go from the ureter(s) through the stoma opening are placed post-operatively to prevent stricture at the ureter / stoma anastamosis site.
When ureteral stents are present, sterile technique must be used when changing a urostomy appliance. Always follow agency policy. The stents are usually removed in the hospital by the surgeon or at the first physician visit. When present, the stents present an extra consideration when changing the flange. |
Ureteral stents facilitate urine drainage from the kidney and the increase the risk for urinary tract infection.
Following principles of asepsis, place the stents on a sterile drape during flange change. This reduces risk of introducing microorganisms into the urinary tract. Care must be taken to avoid accidental removal of the stents during removal of the old appliance and application of the new. Feed the stents into the drainage bag through the hole in the flange. |
| Like ileostomies, the weight of the effluent impacts the flanges ability to remain adhered ot the skin | Change urostomy flanges every 5 days. |
| Urine character from a urostomy / ileal conduit is normally cloudy and can be foul smelling. | Because urine passes through a piece of bowel, the character of the urine will be cloudy from mucous and likely foul smelling from the bacteria that lives in the ileal conduit. |
| Without a bladder, signs and symptoms of urinary tract infection might be different than anticipated
|
Cloudy foul smelling urine is no longer a potential symptom of urinary tract infection. Without a bladder, urgency and frequency are no longer possible. Assess for fever, changes to urine character (changes form the new norem), flank pain. |
| Needing to frequently empty a urostomy pouch can interfere with sleep. | Use a nightime large drainage bag attached to the pouch. When using a large urine drainage bag, the anti-reflux valve incorporated into the bag should prevent backup of urine into the urostomy pouch. |
Copied from Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 11.2 Ostomy Care. https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/11-2-ostomy-care/
Sources:
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
United Ostomy Association of America. (2017). Ileostomy guide. http://www.ostomy.org/uploaded/files/ostomy_info/IleostomyGuide.pdf?direct=1.
3. A client with an ileal conduit has cloudy foul smelling urine in their drainage bag. Which of the following explains the correct thinking of the nurse:
| Distractor | Answer | More information |
| The patient likely has a urinary tract infection | Incorrect | With an ileal conduit, urine is exposed to the pouch made out of a piece of ileum [small bowel] resulting in mucousy foul smelling urine |
| The patient may be experiencing pain with voids | Incorrect | The patient with an ileal conduit no longer has a urinary bladder and therefore will not experience pain with voids. They produce urine but they don’t void |
| The patient requires a flange and pouch change | Inorrect | This character of urine is normal for someone with an ileal conduit. Urine is exposed to the ileum [small bowel] resulting in mucousy foul smelling urine |
| The patient is producing urine as expected following this surgery | Correct | This character of urine is normal for someone with an ileal conduit. Urine is exposed to the ileum [small bowel] resulting in mucousy foul smelling urine |
