Ileostomy Education at High Elevation
Theoretical Case Scenario with Evidence Based Practice Reference
Presented at the Rocky Mountain Region Booth, 2011 Nationals
(When the case scenario was completed, the participant was eligible for a $20.00 WOCN bookstore gift certificate.)
You have just moved to one of the states in the Rocky Mountain Region: AZ, CO, N.M., Utah or Wyoming. You have a patient with a new (R) sided-ileostomy who lives at 8,000 feet elevation.
You are starting your ostomy management teaching and cognizant of the need to maintain adequate hydration while managing potentially liquid output.
1.) How will you customize your educational instructions to emphasize prevention of dehydration and ways to thicken the stool?
2) Do you have any published evidence to support your educational practice decisions?
Responses to Case Scenario Question:
Education Related Response, #1:
Diet and Fluid modifications:Medications/Ostomy Accessories:Assessment:System Approach:Evidenced Based Practice Related Response, #2:
My favorite:
“Drink lots of Coors Beer and eat rice : ) .... Fluids/Fiber”
How can you not appreciate a sense of humor!
Thank you to all who spent the time thoughtfully answering this case scenario!
Increase fluids to combat increased elevation, 8-10 glasses per day
Drink plenty of fluids (about 2000 cc/day minimally)
Measure nutrition and fluid intake and output, replace what comes out
Add foods to thicken stool – peanut butter, cheese, chocolate, marshmellows
To thicken stool: no fluids with meals or 1 hour prior to eating. Metamucil with small amount of water (enough to make it easy to swallow). Decrease spicy foods.
BRAT diet
“After 6-8 weeks after surgery, start introducing foods that would thicken stool, one at a time, to monitor any symptoms of pain, irritation, blockage. Add fiber at this time. Teach pt ileostomy blockage symptoms and what to do if sx occur”
“Applesauce, whole bran, mix and start with 1 TBL BID with 2 cups H20”
“Eat Metamucil fiber cookie if need thicken – can also eat dry toast or crackers. If higher output, may need to replace lytes – sports drinks (Gatorade). May add in thickening foods such as pasta, bananas, etc.)”
Increase fluids, water,Gatorade, broth, pastas, potatoes and chew, chew, chew”
Push fluids, no caffeine drinks, > 1-8 per day. Have pt use Immodium tabs/day to get to thickened stage they like”
"3 liters of fluid daily, Metamucil with each meal to slow transit. Low fiber/low sugar, frequent smaller meals.”
“Thicken stool by increasing food intake with high fiber foods or adding metamucil
Use meds (like Imodium) to thicken stool
If no improvement in stool thickening with diet changes, use lomotil on specified schedule
Each time the pouch is emptied, replace with 8 oz of fluids
Gel Packets to thicken output
“Stool should be kept at oatmeal consistency and monitored (as such)”
Diaries for urinary and fecal incontinence
Multidisciplinary team approach
“I use the info for high output management – fun problem ileostomies. Start with Brat diet, Encourage patients to measure output and replace same amount with oral fluid. If really high output, I refer back to PCP”
Most replies were “no” or left blank
Only one response that noted “Expert Opinion” related to the quality of the evidence
Text book from class
“particularly related to elevation”
Fecal and Urinary Diversions, text book
Use “WOCN Best Practice Statements, Cochrane Library, Johanna Briggs Institute”
