Getting wound and ostomy patients to track daily food and fluid intake is one way to increase their awareness of a balanced diet, which supports normal body functions and tissue repair, nurses say. Nurses can help patients by individualizing care plans and teaching them how various foods, liquids and supplements promote healing and good health.
A wound patient needs to live as well as heal, said Sarah Lebovits, MSN, RN, ANP-BC, CWOCN, DAPWCA, IIWCC, nurse practitioner, Wound and Ostomy Nursing Service at NYU Langone Medical Center. For an ostomy patient, even after the initial wound has healed, the patient will have specific nutritional needs for the maintenance of that ostomy and life, she said.
Patients with wounds need protein to heal, Lebovits said.
They also require foods high in vitamins C and A such as citrus fruits, strawberries, tomatoes, fruit juices, peppers, spinach and broccoli. But eating sufficient calories can be a challenge for these patients because of nausea or lack of appetite.
I teach patients about protein powders, which is great if they dont have an appetite, Lebovits said. The powders have vitamins and minerals, which are necessary for immediate wound healing. So if they are going to eat mashed potatoes, which doesnt have much nutritional value, we tell them to put protein powder on top. The patient wont taste the powder, but it will boost the nutritional value of the potatoes, she said.
Denise Robinson, MPH, BSN, RN, CWOCN, associate director of nursing surgical specialties at The Mount Sinai Hospital in New York, said many wound patients have low levels of hemoglobin and iron and develop iron deficiency anemia. Treatment could include eating iron-enriched foods, and patients may need a dietitian to assist with meal planning.
Most patients could benefit from a dietitian, wound ostomy nurses say.
For ostomy patients, nutritional needs depend on their surgery. A colostomy removes or bypasses a portion of the large intestine, which allows most nutrients to be absorbed. A permanent ileostomy involves the removal or bypass of the entire colon, rectum and anus, which means a significant decrease in dietary absorption. An urostomy involves the bladder, and has minimal effect on nutrient absorption. Ostomy patients can experience a variety of side effects such as gas and odor, said Jennifer Rackley, BSN, RN, CWOCN, a nurse at Cancer Treatment Centers of America at Southwestern Regional Medical Center in Tulsa, Okla.
Gas-producing foods include soy, cabbage, dairy products and onions. Odor-producing foods include asparagus, broccoli, eggs and garlic. Odor can be managed by ingesting cranberry juice and yogurt and adding chlorophyll tablets and deodorizers to pouches. Foods that can cause an obstruction for patients with an ileostomy include dried fruits, nuts and popcorn.
Most of the times, I tell my patients if you just chew your food like we are supposed to, 20 times before we swallow, you can eat these things, Rackley said. Just use caution. You need to cut food up small and you need to chew it well.
Electrolyte imbalances are another possible problem for these individuals, so keeping hydrated and avoiding caffeinated drinks is key, she said.
Some ostomy patients are at risk for diarrhea, which can be alleviated by such foods as applesauce, peanut butter, bananas and bread. Constipation, which colostomates are at risk for, should be treated with foods that have more water and fiber.
Robinson said additional tips for ostomy patients include avoiding skipping meals since empty bowels produce gas, eating small frequent meals, chewing food thoroughly, eating starchy food once daily to avoid irritation, limiting simple sugars to avoid onset of diarrhea and drinking six to eight glasses of water daily and not with meals.
Outreach also makes a difference, said Elizabeth Lizzi M. Savage, MSN, RN, ACNS-BC, CWON, a clinical nurse specialist in the Wound and Ostomy Nursing Service at NYU Langone Medical Center.
Every single one of our ostomy patients gets an email address that goes to all three of the certified ostomy specialists here, Savage said. They can email us day or night. We have our work phones on us and we answer whether its the middle of the night, the weekend or a holiday. We provide that as a service so that patients have a way to connect with us if they have a question.
We are able to guide them…whether they need to come see us or if they can remain at home. It really is cost effective because it saves healthcare dollars as well as its a nice service we provide and it make patients very happy.
Another best practice Robinson said wound ostomy nurses endorse is to allow the patient to be a part of the plan of care.