Nutritional Management of stomas
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1 Nutritional Management of stomas Tracy Russell Specialist Dietitian Western General Hospital, Edinburgh Mairéad Keegan Dietetic Team Lead Hairmyres Hospital, East Kilbride
2 Overview of Presentation General Dietary advice for Stoma Nutritional Screening who, what, when and why? Resources Initiatives in Practice Management of High Output Stomas Protocol Development Conclusion Questions
3 Interactive Question I feel confident about the dietary advice I give to my patients? a) Yes b) No c) Not sure
4 What Can I Eat??
5 Dietary treatment goal Dietary advice for pts post stoma formation is key to rehabilitation but remember dietary intake is very individualistic stoma output Maintain hydration/electrolyte balance & nutritional status
6 Ostomies Regular meals, little and often Relax whilst eating Sit down at table Don t drink and eat at same time prevents wind Dentures fit well Chew food thoroughly
7 Colostomy Healthy Eating No dietary restrictions Consider Individual intolerances
8 Ileostomy Initial high output should settle over time Try not to drink whilst eating Ensure adequate fluid and salt intake post-op (Fluid and Electrolyte status depend on bowel length) Healthy Eating Consider Individual intolerances Slight restrictions?
9 What about Blockages No Clinical Trials on diet and blockages Anecdotal and expert opinion!!! Chew food well Take your time eat slowly Drink plenty fluids after eating Food diary and symptoms (identify tolerances to foods: everyone is different)
10 What about Blockages Colostomy - very rare Ileostomy - may occasionally block with undigested food 6-8 weeks following surgery: Avoid Fibrousy foods e.g. skins and seeds, sweetcorn, peas, celery, bean, lentils, pineapple, tomato skins, coconut, nuts, raisins Re-introduce these foods slowly
11 What about Fibre??? Should be encouraged as part of a healthy diet in both Colostomy and Ileostomies (once normal output has been established) Obviously be aware of individual judgement and tolerance Re-introduce slowly?
12 Dietary management of Wind Odours/smells Loose stools/diarrhoea No more than 5 fruit/veg daily No more than 150mls fruit juice Limit alcohol intake Limit caffeine Trouble shooting!
13 How can I thicken my output? Under ripe bananas White rice, pasta, noodles and bread Low fibre breakfast cereals Porridge Foods that contain gelatine e.g. marshmallows, jelly babies
14 Intestinal Adaptation Post-op period, spontaneous intestinal adaption occurs to minimise the consequences of intestinal resection Presence of nutrients in the GI lumen is essential to take advantage of this process, so pts should not remain NBM for extensive periods of time Reaches plateau 2 yrs. post resection Unknown what the optimum diet is to promote adaption (Culkin 2014)
15 Interactive Question I always ask my patients about recent weight loss and changes to dietary intake? a) Yes b) No
16 Nutritional Screening Who? Every Patient you see Why? Identify those at risk of, or who are malnourished Define outcomes Monitoring progress/decline Who does it? All Care workers and Health Care Professionals Don t presume someone else is doing it! When? First Assessment /ideally early as possible Think about screening though-out patient journey Use in hospitals and community What? Nutritional Screening tool investigate local policies MUST: Malnutrition Universal Screening Tool * * Subjective Global Assessment
17 What do you need? Scales Tape measure Eyes!
18 Nutritional Screening Tools! Check which tool is being used locally e.g. MUST Check how to refer to local dietetic service
19 Nutritional Screening Consider Weight loss in last 6 months or when symptoms started BMI Factors affecting nutritional status High Output Stoma! Obstruction leading to NBM/Ileus Enteral feeding tube in situ Parenteral nutrition Texture modified diet Restricted Volume De-hissed Wounds/Poor wound or pressure sore healing (Grade 3 and above)
20 SGA Subjective Global Assessment: Loose clothes/dentures/rings, wrinkly/dry skin, sunken eyes Muscle wastage Weight change Change in appetite Nausea/vomiting/diarrhoea Change in functional capacity
21 Nutritional support tips First line advice Little and often High calorie snacks between meals Drink after a meal not before or during Yoghurts full fat, pudding pots Add cream/cheese/marg/butter/grated cheese to potatoes/soups/sauces/pasta dishes Use full fat milk, 1 pint daily e.g. cereals, puddings, hot chocolate Fortified milk add 4 tablespoons dried milk powder into 1 pint full fat milk
22 Resources? Research Papers very little Booklets Ensure same information is given within team what is used in your area? When is best to give - Pre-Op or Post-Op
23
24 Ward Initiatives! Aim Patient empowerment Improve confidence in eating after surgery Improve knowledge Team work!
25 Pre-op Booklets
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