Describe how you will explain an ileostomy to Kelly. Use a simple diagram to aid in your teaching.

Description of surgery: colectomy, subtotal proctectomy, and possible removal of mucosa from the rectal stump. The reservoir will be created and attached to the rectal stump. There will be an ileostomy created to allow healing of the internal pouch.

Kelly’s parents express a desire to be present during your teaching session. What is your response to them?

You will need to discuss with Kelly whether she wants her parents present during the teaching sessions. Since she is 19-years-old, so that decision is up to her.

Kelly is 5’8” and currently weighs 106 lbs. She will see the dietician after surgery, but describe some general dietary and hydration guidelines that she will need to follow after her surgery.

Dietary guidelines include the following:

Avoid foods high in insoluble fiber for the 1st 6-8 weeks post-op
Add foods high in insoluble fiber one at a time in small amounts; chew thoroughly
Monitor response to each new food (cramping and increased output are indicators that food is poorly tolerated)
Kelly will also need to implement measures to prevent dehydration

She should drink at least 8-10 glasses of fluid a day
She should drink a glass of replacement fluid each time she empties her pouch
She should include fluids that contain electrolytes, as well as water, tea, coffee, etc.
She should monitor for early signs and symptoms of dehydration

Describe pouching guidelines for the patient with an Ileostomy. What factors will you consider in selecting a pouching method for this patient?

Must consider stomal height, location of os, abdominal contours, and volume/consistency of output. Must protect all peri-stomal skin with the pouch or a barrier ring or paste.

It has been two weeks since Kelly’s surgery. She calls the clinic complaining of only liquid output, some abdominal distention, and cramping. She had pizza with mushrooms for dinner last evening. What is your assessment of Kelly’s symptoms?

Findings are consistent with a partial food blockage.

Kelly calls back two hours later and reports that she cannot relieve the blockage. What will you advise her to do?

Kelly should be directed to go to the ED for assessment and possible ileal lavage.

Kelly calls you one week later. She had been with a family member who had a “stomach bug” and now she is having episodes of diarrhea. She is emptying her pouch every 1-2 hours and describes the output as “watery”. She denies vomiting. What is your advice to her?

Discuss signs of dehydration (dry mouth, dark yellow urine, reduced urine output, nausea, weakness, and dizziness). If she denies these symptoms, she should begin drinking fluids. A general rule is one glass each time she empties her pouch. Advise her to drink fluids with Na+ and K+ (broth, sports drinks, etc.). If she is able to eat, she should adhere to the “BRAT” diet (bananas, rice, applesauce, tea, etc.). If she has symptoms of dehydration, is unable to tolerate fluids, or if the diarrhea continues, she should notify her MD immediately. She may need IV fluid and electrolyte replacement.