ileostomy output

[blackribbon]

I had a patient this week with what is supposed to be an ileostomy. She was in for abdominal pain around the area of her stoma radiating to her back and was c.diff positive. The main nursing activity was controlling the pain, caring for a pressure ulcer on her iliac crest, and trying to get the output to stop being so watery??? When I got her, I was handed off that they were happy the output was starting to become "formed again" (it is hard to describe what it looked like but yeah, it was getting some texture to it). Isn't ileostomy output supposed to be watery? I had her for two nights and neither day shift nurse could tell me why we wanted "formed" stool in her bag. I finally went in the last day and asked the patient if she had an ileostomy or a coloscopy ... and she replied that she used to have a coloscopy but in January, changed it to a ileostomy. But nobody had educated her on the difference in outputs either..and she wasn't really sure of what the goal was either. I told her I was going to learn more about the differences on my days off but she should ask the ostomy nurse what she should be expect her output to look like.

Also, this patient was great and after I did her dressing change and we had discussed ileostomies vs coloscopyies, I asked if she would allow me to listen to her bowel sounds all over her abdomen because I was tired of looking at prior shifts charting "bowel sound x4"...she only had part of a colon so I know they weren't really hearing BSx4..and I discovered that yes, she had sound in all four quadrants where you would expect them but I also heard them near her naval and just above her public area ... in other words, you could hear sounds everywhere. It was kind of cool but since she didn't have a whole colon, BSx4 was not proper charting. We chart in Epic...how would you chart small bowel sounds?

[JustBeachyNurse, LPN]

Why wouldn't you chart that you heard bowel sounds in all quadrants?sounds resonate and organs move to fill dead space. many patients have bowel sounds over the navel and over the pubic bone so this is not a unique finding.

[blackribbon]

Isn't the purpose of assessing bowel sound to verify that the colon is functioning correctly over the length of the colon ... not an assessment of the small intestines?

I know I was chastised for leaving the tract of the colon when I assessed sound in clinicals. Was that instructor wrong?

[JustBeachyNurse, LPN]

Isn't the purpose of assessing bowel sound to verify that the colon is functioning correctly over the length of the colon ... not an assessment of the small intestines?

I know I was chastised for leaving the tract of the colon when I assessed sound in clinicals. Was that instructor wrong?

Bowel sounds assets for the sounds of peristalsis that are made by small intestine, large intestine and stomach. You cannot determine presence or absence of colon by bowel sounds but you can tell presence of digestive tract peristalsis by auscultation. In a patient with total colectomy they likely have positive bowel sounds in all four quadrants. You may also auscultation vascular sounds especially if a patient has an aneurysm.

Assessment of Bowel Sounds - Ausmed

[JustBeachyNurse, LPN]

Ileistomy output can be soft formed/pasty. It all depends. And pasty would be an indication of reduction of c diff and increased nutrient and and fluid absorption.

http://www.ostomy.org/uploaded/files/ostomy_info/IleostomyGuide.pdf?direct=1

[blackribbon]

thank you

[woundnurse4u]

Pasty output is typical for an ileostomy. The dangers with an ileostomy are dehydration and electrolyte imbalance (more likely to occur with diarrhea). Also be aware that there are dietary restrictions with ileostomies to prevent food blockage. Many ostomy supply companies offer tip sheets and some have free CEUs for nurses on their websites.