Ostomy Care

  

Name: ____________________________________           

Date:    _________________

Ostomy: ___________________________________

 

Supplies:

□ Wafer/barrier______________________	□ Pouch___________________________
□ Adhesive remover_________________	□ Skin prep________________________
□ Paste____________________________	□ Stomahesive powder – use only when needed * see steps below
□ No sting barrier  - use only when needed * see steps below	□ Bedside urine bag__________________
□ 4x4 nonsterile gauze pack___________	□ Urine bag connectors_______________

□ Low pressure adaptor – size ___ (optional). May continue to use until abdominal tenderness is relieved.  Attach to wafer before applying wafer to abdomen.

□ ____________________________ □ _______________________________

 

 

Change Pouch System every 3-4 days and more often if needed.

 

1. Prepare wafer: mold starter hole to stoma size/shape
2. Remove old wafer/pouch system with adhesive remover.
3. Clean skin around stoma with lukewarm water.  Dry.
4. Apply skin protectant on skin around stoma.  Dry.

* If skin is irritated, red, or raw, apply stomahesive powder on the irritated skin only, dust off excess, blot with no sting barrier (lollipop) on powdered areas.  Or you may blot with moistened fingertip.  Repeat x 2.  Dry.  Use rest of no sting barrier to protect intact skin around stoma.  Do this only on irritated skin.

 

Empty pouch when 1/3 full.  Clean inside of tail end closure after being emptied. 

Drink at least 10-12 8oz glasses of liquid per day (or as allowed).

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5. Apply pouch

• To low pressure adaptor
• To wafer

 

If using a 2 piece system, check coupling system to ensure system is completely closed.

 

To secure invisiclose tail end closure for drainable pouch (Velcro), press interlocking closures together until you feel them lock or click into place along their entire length.  Do the same with the security flap. 

 

Go to the nearest emergency room if stoma turns dark color (dusky blue, grey, brown or black) or if stoma is bleeding. 

 

For other concerns, questions or problems, call Ostomy Nursing:  608-263-8084 or

608-263-5449

 

Notes:

 

Discharge Ostomy Supplies

 

We will provide you with enough supplies until your first clinic visit. 

The cost of ostomy supplies should be covered by your insurance.  Check with your insurance company to find authorized providers of ostomy supplies. You may also ask your home health nurse or your local pharmacy where you can get your ostomy supply prescription filled.

 

Medicare patients:

 

Medicare will pay for 80% of the cost.  If you have supplemental insurance, the other 20% should be covered. 

 

Home health agencies (if needed) will provide supplies for you until you no longer need their services.  When discharged from home health, call us at 608-263-8084 and leave a message for the ostomy nurse with the name of your preferred provider of supplies.  We will fax your prescription to them.  They may mail them to you or you may need to pick them up.  Your provider may set a regular schedule to deliver your supplies.  Others want you to call when you need more. 

 

Private insurance or HMO patients:

 

Many private insurance plans or HMO’s will pay the full cost of the supplies as long as they have been prescribed by a doctor.  Check with your insurance provider about what they require for refills. 

 

If you use home health, they will not provide supplies.  A prescription for ostomy supplies will be faxed to your provider after your first post op clinic visit.

 

If you do not need home health, you will be discharged home with enough supplies until your first clinic visit.  At that time you will receive a prescription for more supplies.  We can fax this to your provider or you may take it with you. 

 

Do not order too many supplies before your first clinic visit.  Most stomas shrink.  You will likely need a new prescription with your new wafer/barrier size at that clinic visit. 

 

We may change your ostomy supply prescription during the first months after discharge.  After 6 months, if your ostomy supply needs have not changed, you may request refills from your primary care doctor.

 

Colostomy and Ileostomy Diet Guidelines

 

Adequate nutrition is important to your well-being.  The foods you choose to eat provide both nourishment and pleasure.  All of the foods you enjoyed before surgery, with a few exceptions, should be well tolerated now that you have an ostomy.  Many people with ostomies can enjoy a normal diet; however, food tolerances can vary from person to person. 

 

General guidelines that will help make caring for, and eating with, your ostomy easier include:

 

• Eat meals regularly.  You should eat three or more times a day.  Small frequent meals may be better tolerated and produce less gas.

 

• Chew your food thoroughly.  Chewing well will help avoid a blockage.

 

• Eat in moderation and slowly.  Too much of any food can cause problems, so eat moderate amounts and eat slowly to allow for proper chewing and digestion.  If a new food seems to give you problems, don’t eat it for a few weeks, but try it again later.

 

• Drink plenty of fluids daily.  You may lose more body fluids then usual through the ostomy, so it’s important to stay hydrated.  Patients who have lost a large part of their large intestine will especially notice more fluid loss.  This is because most of the body’s fluid is normally reabsorbed in the large intestine.

 

• Above all, remember that no two people will react the same to foods.  You will learn through experience which foods, if any, you should avoid.

 

Reducing gas and odor

 

Gas is normal but if you feel you are having excess gas, you may try to change your diet to eliminate the problem.  Try these tips:

• Eat regularly.  Do not skip meals.
• Avoid swallowing air while eating. Relax and eat slowly.
• Avoid chewing gum or drinking through a straw.
• Drink 8-10 glasses of water, cranberry juice, or other non-caffeinated beverages.

 

Foods that may cause gas or odor

 

Asparagus	Cabbage	Dried beans/peas	Onions
Apples	Carbonated beverages	Eggs	Prunes
Bananas	Cauliflower	Fatty foods	Radishes
Beer	Corn	Grapes	Turnips
Broccoli	Cucumber	Green pepper	Beans
Brussels sprouts	Dairy products	Melons	Mushrooms

 

Foods that may help prevent gas and odor

 

Yogurt with Active cultures

Buttermilk

Cranberry Juice

Parsley

 

Preventing Blockage

 

Certain foods, if eaten in large amounts and not chewed well, may cause blockage.  Use caution when eating thesefoods.  Eat them in small amounts and be sure to chew them thoroughly.

 

Celery	Dried fruits	Nuts	Popcorn
Coleslaw	Meat casings	Peas	Salad greens
Corn, whole kernel	Mushrooms	Pineapple	Seeds

 

The consistency of your stools is determined to a certain extent by the location of your stoma in your gastrointestinal (GI) tract.  Normally, when the stoma is placed further up in the GI tract, the stools tend to be looser.  In some cases, a loose stool may be the result of eating certain foods. 

 

Foods that may cause loose stools

 

Alcoholic drinks	Chocolate	Fried Foods	Licorice
Apple juice	Coffee	Grape Juice	Prune juice
Baked beans	Dairy	Green leafy vegetables	Spiced foods
Tomatoes

 

Foods that may help thicken stools

 

Applesauce	Cream of rice	Peanut butter (creamy)	Tapioca
Bananas	Marshmallows	Rice	Weak tea
Cheese	Mashed potatoes	Soda crackers

 

A Special Note for Ileostomy Patients

 

A person with an ileostomy loses large amounts of salt, potassium and water in the ostomy fluid.  Losing too much can lead to dehydration.  You need to include several good sources of sodium and potassium in your daily diet.  It is helpful to consume water or sugar free, non-carbonated beverages throughout the day.  Sports drinks can be used because of their electrolyte content.  The color of your urine should be clear to pale yellow, if it is darker increase your fluid intake.

 

In general, meats, legumes, vegetables, and fruits are good sources of potassium.  Some examples include bananas, orange juice, tomatoes, and potatoes.

 

Most importantly, remember to eat a healthy, well balanced diet and drink plenty of fluids!!

 

 

Internet resource for patients who have an internal ileal pouch:  www.J-pouch.org

 

If you have more questions please contact UW Health at one of the phone numbers listed below.

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/10/2011

Copyright © 03/10/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6279

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