Giving stoma or colostomy diet advice can be difficult because there are multiple types of stoma and sometimes people need to adjust their diet after bowel surgery, in the short term or for longer. Furthermore, not everyone with a stoma needs to change their diet after colon surgery or bowel surgery. This guide has been designed to give some helpful hint and tips, but it is always best to discuss with your Doctor, Specialist Nurse, or a Registered Dietitian before making dietary changes. Show
Foods to Avoid with a StomaSome people find that caffeinated drinks such as coffee, tea and cola-style drinks can over stimulate their bowel and cause foods to pass more quickly through the digestive system. Moderate to heavily spiced foods are also common irritants to a sensitive bowel. Some people have sensitive guts to ‘rich’ meals that are high in fat. Choosing lower fat options or having smaller portions of these foods can help reduce symptoms and improve digestion. Our first piece of advice is always ask your stoma care nurse what is best for you, they can explain which foods to avoid with a stoma and recommend the best stoma diet for you. The second piece of stoma diet advice is to let your stoma settle and then to just try small portions of each food and see what effect they have. If you’d like more information on foods to avoid with a stoma sign up to Ostomates Kitchen for free here. Once you sign up you will also get some stoma diet recipes and meal ideas for stoma patients. Low-Fibre DietThe normal recommended ‘healthy diet’ is high-fibre, low-salt, and low-fat. However, this may not be the ideal diet for stoma users. The gut can be extra sensitive within the first 6-8 weeks after surgery. A sensitive gut or bladder is more likely to be irritated and this can mean food and fluid passing through the body quicker than normal; this can cause cramping, bloating, a more liquid stool, or a higher production of urine. Following a low-fibre or low-residue diet after surgery may help reduce these symptoms. However, there is no strong clinical evidence that a low-fibre diet is needed long-term in those with urostomies, colostomies or even ileostomies. If you are experiencing any of these symptoms after surgery, you can try swapping high-fibre foods to low-fibre alternatives. For example, swapping wholemeal bread to white bread, and brown pasta and rice to white pasta and rice, will help to reduce your fibre intake. Also swapping fibrous, stringy fruit such as rhubarb, pineapple, figs, and dates with pealed or skinless soft fruits such as strawberries, bananas, and melon. For a complete list of low-fibre foods and low-fibre diet menu examples sign up to Ostomates Kitchen here. Download our leafletDietary advice for people living with a stoma (825 KB) ANSWER AND RATIONALE 1. D, F, G, H 2. A, B, C 3. A, B, C, E 4. A, B, D, E 5. D, B, C, A 6. C, D, A, B 7. C, D, E 8. A, B, C, D 9. A, B A nursing diagnosis is a clinical judgment about a response to an actual or potential health problem. This client is manifesting symptoms of both hopelessness and powerlessness. Although the client does report symptoms compatible with fatigue, there is no direct data is given that indicates the client has interrupted sleep patterns (option 3), disturbed self esteem (option 4), or self care deficit (option 5). 10. B, C, D The diagnosing phase of the nursing process involves data analysis, which leads to identification of problems, risks, and strengths and the development of nursing diagnoses. Collecting and organizing client data is done in the assessment phase of the nursing process. Goal setting occurs during the planning phase. 11. A, B Collaboration with the client and family will encourage a sense of autonomy and active involvement in the healthcare process for the client. In this case collaboration with other nursing staff will ensure the successful implementation of the planned intervention. There is no real need for collaboration with hospital administration or the security department in this situation although the nurse should be aware of her responsibility to collaborate at those levels when the situation demands it. 12. A, B, C, D Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema, the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high Fowler's position to ease the work of breathing. Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to measure output accurately. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and also reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client's response to treatment is successful. 13. B, D, E Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache, visual disturbances such as diplopia, blurred vision, yellow-green halos, photophobia, drowsiness, fatigue, and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. 14: B,
C, D, G 15. A, C, D 16. B, C, E, F 17. B, D, E 18. B, A, E, C, D 19. A, D, E 20. D, F, G,
H 21. A, B, C, D 22. C, A, D, B 23. A, C, D, E, B 24. A, B, E B. Laparoscopic surgery involves insufflating the abdominal cavity with air, which is painful until it is absorbed. The amount of pain should be measured and documented with either a 1-10 scale or the Wong's FACES for younger children. C. A special diet is not indicated after this surgery. D. After a laparoscopic appendectomy, there is little drainage and no dressings. E. Auscultating for bowel sounds and documenting their presence or absence evaluate the child's adaptation to the intestinal trauma caused by the surgery. 25. A,B,D The patient with sleep apnea may have insomnia and/or abrupt awakenings. Patients with cardiovascular disease (e.g., heart failure that may affect respiratory health) may need to sleep with the head elevated on several pillows (orthopnea). Sleeping more than 8 hours per night is not indicative of impaired respiratory health. Which food should the nurse offer to a client who has been prescribed a full liquid diet?Full liquid diet –
cereal, custard, strained cream soups, and juices with pulp.
Which substances would the nurse advise a client to avoid to limit gastrointestinal irritability?Typical recommendations are following a regular eating pattern and limiting the intake of potential dietary triggers, such as alcohol, caffeine, spicy foods, and fat[12,13].
In which position should the nurse place the client during the enema?The left lateral position is the most appropriate position for giving an enema because of the anatomical characteristics of the colon.
Which juice is the most appropriate for the client on dietary intervention for GERD?GERD Diet. |