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Confused- GI nurse question

Posted

Specializes in Medical Surgical RN. Has 2 years experience.

Hello,

New grad, my patient had creation of transverse colostomy, three days go by and no output. Patient was NPO for 3 days prior and remained NPO 4 days after colostomy creation. Since no output, surgeon placed a rubber Foley catheter inside the stoma. No output 2 days after. I asked why still NPO and they said because colostomy isn’t working. Patient without food for 9 days now and I don’t understand how they expect stool with no nutrition. Patient was just getting LR IV, no TPN or feeding tubes. Can anyone offer any explanation?

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

Patients who are permanently NPO have BMs once in 7 to 10 days if they have any significant length of bowel because mucous lining still sheds and some secretion and peristalsis still continue.

In your case, we need evidence of returning bowel function before patient can be given anything PO. Bowel sounds, passing flatus and discharge (stool or stoma discharge) are indicators of returning bowel function. If there are none of them, patient needs to be NPO with IV hydration.

Some things you can do as a nurse to support bowel function is using whatever measures you can to limit pain killers, especially opioids, actively ambulating the patient, keeping him well hydrated, controlling both hypertension and hypotension and correcting electrolytes alterations.

Stoma not working for 6 days is getting kind of worrisome, but the management really depends on surgeon who was actually holding the bowel and so knows the condition of it at the time of stoma creation, level of injury, etc.

PGHNurse412, ASN

Specializes in Medical Surgical RN. Has 2 years experience.

That makes sense thank you! Pt was paraplegic so no moving, they actually created colostomy to help aid in the healing of a sacral wound. Opioids and hypertension was most likely the cause!