By Mary Ellen Posthauer RDN, CD, LD, FAND
While the focus of nutrition interventions for wound healing involve the amount of protein, calories and beverages provided and consumed, we tend to forget the importance of good oral hygiene.
By Janis E. Harrison, RN, BSN, CWOCN, CFCN
"What did I get myself into?" There were several times over the first 10 years of my 20 year marriage to a person with an ostomy that I had to ask myself that question. Then came the revelation of the old saying "if you can't beat 'em…. join 'em." I decided that after major problems my spouse had with several surgeries – which included ostomy revisions, fistulae, abscesses, and surgical wounds – I would need to learn much, much more if I was going to spend the rest of my life with my husband, Daryl, and his maladies.
When I first met Daryl, his having an ostomy did not scare me. I had worked with ostomies in the hospital and nursing home settings for 12 years as an LPN. Thus, it was easy for me to accept. When I returned to school for my BSN, there seemed to be little more than a paragraph and a one hour lecture by an ostomy nurse to arm us with what was supposed to be a greater and higher understanding of ostomies. After the surgeries I felt like I had been armed with a pea-shooter.
He had his colon removed due to Chronic Ulcerative Colitis four years prior to my meeting him. As a teacher, Daryl planned everything around his breaks and holidays. Ten years ago, after losing 85 pounds, he scheduled an incisional hernia to be repaired during the Easter Break and return immediately to his teaching. Even as a new RN, I had no idea about diet for a person with an ostomy, nutrition, fluid requirements, medication considerations, or even possible surgical complications. I was definitely not prepared for what took place on that long Easter weekend that was supposed to be a simple incisional hernia repair.
Tune in again next time for the continuation of this saga as I have so much more to tell you.
For someone with an ostomy, diet and nutrition becomes a concern. Hydration is a major concern for someone with an ileostomy – the stoma is formed from the ileum or last portion of the small intestine before joining the colon. Most of the fluid intake is absorbed by the large intestine before the bolus reaches the rectal vault.
In the individual with an ileostomy, the absorption has to take place in the small intestine. Too much fluid during a meal can wash away the necessary nutrients the body needs to function and wounds need to heal. Many times these individuals are at risk of fluid and electrolyte imbalances. They are unable to absorb enough protein, calories, and vitamins – all of which are essential in wound healing. Diets are restricted immediately after surgery.
Adjustments can be made by adding supplements to the nutritional regimen. There are many commercial supplements such as Ensure, Boost, Resource, ProStat, etc. I have always read nutritional facts on grocery products to find items that are tasty, nutritionally superior, and cost-effective. Special K bars, water, cereal, and various products have a high protein content. I recommend the protein bars found in the vitamin aisle, as well as Carnation Instant Breakfast (if not lactose intolerant) as this is high in protein and low in cost. It can be added to ice cream for a shake or just added to milk. Keep in mind the supplement should not be taken in place of a meal. Supplements are in addition to the nutrition and calories of the meal. Another suggestion for the ostomate is to eat several times a day in smaller quantities, using many of the products in your pantry or refrigerator. Crackers with cheese, or peanut butter are handy snacks to have close by.
Not enough fluid intake can cause dehydration and blockage. The small intestine will adapt over time to the individual's dietary and fluid needs. Therefore, it is recommended the individuals with ostomies consume 10 to 12 8-ounce glasses of liquid per day. Water is good as well as juices. I usually recommend the various sports drinks such as Gatorade, Powerade, clear non-diet sodas, etc. Fluid consumption should be increased if symptoms of dehydration are noted, such as: increased thirst, fatigue, decreased or dark urine, abdominal cramping or leg cramps, feeling faint, or dry mouth to name a few. Be aware, juices and other fluids can cause dumping in some patients. Dumping will be counterproductive as not only is the fluid consumed lost, but all previously consumed nutrition in the tract will be taken with it. If diarrhea is the cause of dehydration then I find the best thing to give my husband is pasta. This helps him almost immediately.
In most cases the individual is feeling so much better than they did before surgery that once past the post-operative period, the patient tends to eat and drink more. The person with an ostomy should be encouraged to eat new things in moderation and self-evaluate their experience. Daryl was advised to not eat nuts, mushrooms, popcorn, or olives. No one could justify why. He found through self-evaluation that most of the items caused no problem at all. Popcorn had to be with copious fluids or his intestine became blocked. Nuts simply were a pain to empty from the pouch.
Side note: My husband lost another 35 pounds from his simple incisional hernia repair and was hospitalized with dehydration and resulting bowel obstruction. Another old quote comes to mind, "You are never too old to learn something new." I learn every day and look forward to sharing more with you in future blogs.
About the Author
Janis Harrison is the CEO and owner of Harrison WOC Services, LLC, which offers contractual Wound, Ostomy and Continence (WOC) services for hospitals, long-term care facilities and home health across Northeast Nebraska. Harrison has had numerous poster published, is a writer for Advanced Tissue's newsletter and is currently involved in developing health care documentation applications.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.