Nikki Finkenthal

KNH 411
Professor Matuszak
Case Study #13
1. Describe the partial colectomy procedure. How does this change the function
of the gastrointestinal tract?
The function of the gastrointestinal tract is changed after a colectomy due
to the fact that a creation of an ileostomy is put to use. Adaption of the
new function takes roughly 1-2 weeks to occur. The fecal output will
lessen and stool will become less liquid based (Krause 2012, p. 640).

2. What is a colostomy? What kind of fecal output can Ms. Watson expect?
A colostomy exists when the rectum only is removed and the end of the
colon is surgically attached to the stoma. Ms. Watson can expect to utilize
a pouch appliance to collect her waste products. Ms. Watson can expect
firmer and more normal stool output due to the fact that she had a
colostomy. (Nelms 2016, p. 424-425)

3. The physician has ordered a consult for Ms. Watson for teaching regarding
the care of her ostomy. What is an enterostomal therapist? Describe this
specialists training and what he or she will most likely teach Ms. Watson.
An enterostomal therapist is an individual who specializes in the care of
stomas and they play a vital role in supporting patients during post-op, as
well as teaching the patients how to care for it. A major key for these
patients is the acceptance of their new condition and addressing the
problems involved with maintain bowl regularity, due to the inexperience.
The enterostomal therapist can teach Ms. Watson how to properly examine
her stools in order to determine which foods in her diet need to be
eliminated. (Krause 2012, p. 639-640).

4. What is the typical postoperative sequence for nutritional intake? How long
will Ms. Watson be NPO?
At first the plan for Ms. Watson is to be NPO with ice chips. Her surgeon
states that she will be NPO for the first 3-5 days. After her NPO phase the
patient will then be transitioned to an oral diet. Typically the patient begins
with liquids and later starts to include low residue foods into the diet, if
tolerable. If the feedings start earlier after post-op the patient typically has
a shorter hospital length stay. All foods that can cause stoma obstruction
must be avoided for the first 6-8 weeks after surgery. The typical
postoperative sequence for nutritional intake will be to start of with small
bites of foods and chew thoroughly, eat small meals throughout the day,
eating the largest meal in the middle of the day to decrease stool output at
night, avoiding spicy/ fried foods, increase foods that can thicken stools
such as bananas, dont not drink from straws, smoke or chew gum/
tobacco and have at least 8-10 cups of fluids per day (Nelms 2016, p.
425).
5. What are the nutrition therapy recommendations for someone with a
colostomy? How would this be different if she had an ileostomy?
The overall goals for nutrition therapy after a colostomy is to decrease the
risk of obstruction, maintain normal fluid and electrolyte balance, reduce
excessive fecal output and/ or change consistency of output and minimize
gas/ flatulence (Nelms, 2016 p. 424).

6. Evaluate Ms. Watsons %UBW and BMI.

Ms. Watson currently weights 163 lbs and is 54 which gives her a BMI
value of 28.0 kg/m2 putting her in the overweight category. Her %UBW
would be 94.2% because she currently weights 163, but previously was at
173 pounds but lost the weight.

%UBW= current body weight/ usual body weight x 100

= 165lbs / 120 lbs x 100 = 138%

7. Calculate Ms. Watsons energy and protein requirements.

Adjusted body weight = 120 + 0.25 (175 lbs -120 lbs) = 134 lbs / 2.2kg =
61kg
Energy= (10 x 61kg) + (6.25 x 163 cm) (5 x 61 161) x (1.5) = 1700-
1800 kcals/ per day
Protein= based of 1900 kcals per day
.8g/ 61kg = 49 g protein/ per day
49 x 4= 195 kcals/ per day

8. Identify any significant and/ or abnormal laboratory measurements for Ms.

Watson. Explain possible mechanisms for the abnormal labs.
Major significant and/ or abnormal changes in Mrs. Watson include:
-10 pound weight loss- which is a very significant number, and change in
weight
-Elevated levels of glucose- due to her diagnosis of type 2 diabetes
-Elevated levels of osmolality- due to dehydration
-Elevated levels of C-reactive protein- due to inflammation from trauma
after her surgery
-Elevated levels of Cholesterol due to her BMI of 28.0 kg/m2
(overweight)
-Elevated levels of LDL- due to her BMI of 28.0 kg/m2 (overweight)
-Elevated levels HbA1c- due to her diagnosis of type 2 diabetes and her
high blood sugar levels
-Low levels of hemoglobin/ hematocrit - due to these low levels in both of
these lab measurements its possible that she can
be anemic
9. Select two nutrition problems and complete the PES statement for each.
-Inadequate levels of iron related to iron deficiency anemia as evidence by
low levels of hemoglobin and hematocrit
-Overweight body status related to poor dietary choices as evidence by a
BMI of 28.0 and history of type 2 diabetes and hypertension

10. The surgeon notes Ms. Watson probably will not resume eating by mouth for
at least 3-5 days. Using ASPEN guidelines, what would be your
recommendation for nutrition support for Ms. Watson?
Prior to gastrointestinal procedures the body is in a state and cycle of
metabolic stress. The ability to meet the needs for each patient by an oral
diet may be inhibited due to the length of time needed to recovery from
surgery. Its difficult for doctors and patients to assess when the GI
function has truly returned so the post-operative feeding times are still
being debated. A standard nomogram of 25-35 kcal/ kg per day can be
used, but the energy needs is truly based on individual needs. Protein
requirements are elevated above the RDA of 0.8 g/kg per day and Ms.
Watson should consume 1.2-1.5 g/kg IBW per day. Overall the needs that
Ms. Watson will need to recovery properly are based truly on an individual
basis (Nelms 2016, p. 680-681).

11. For each PES statements you have written, establish an ideal goal (based on
the signs and symptoms) and as an appropriate intervention (based on
etiology).
-An ideal goal for inadequate levels of iron would be to increase the levels
of iron by adding iron supplements and iron dense foods into her daily
caloric intake
-An ideal for overweight body status would be to lose weight and reduce
her BMI levels to a more fitting status. The intervention for this would be
to reduce foods high in saturated fats, sodium and sugar. Mrs. Watson can
keep a food log that we can monitor in order to keep track of her daily
consumption. She can also incorporate more physical activity into her
daily routine, which will help reduce weight at a faster pace.

12. What would be the primary nutrition concerns as Ms. Watson prepares for
rehabilitation after her discharge? Identify two nutritional outcomes and
outline specific measures for evaluation.
Due to the type of surgery Ms. Watson had her body is in a state of metabolic
stress, which is the most challenging and demanding type of environment for
nutritional care. There is an increased risk of inadequate nutrition support
within these types of surgeries. Due to the limitations of her oral-diet and the
fact that her GI tract may still be sensitive Mrs. Watson may have a reduced
desire to eat during a time frame where her body is trying to heal. Thus her
needs for protein and other vitamins need to be increased, in order to avoid
deficiencies and lack of proper healing. The first nutritional outcome is the
possibility of inadequate protein due to the restriction of eating and the need
for proper healing. The way to make sure she is receiving the needed amounts
of protein would be to measure the levels of protein present in her blood. By
checking her bilirubin levels and taking a 24-hour recall the dietitian can see
make sure that she is consuming enough protein to heal properly. The second
nutritional outcome could be low and inadequate levels of vitamin C and zinc.
The addition of vitamin C increases the collagen needed to repair tendons,
ligaments and cure surgical based wounds, which Mrs. Watson will possess. If
vitamin C and zinc supplements are added into Mrs. Watsons diet she can
make sure to maintain proper levels of these nutrients and have a successful
recovery. The proper measurement for this would be to take laboratory tests to
make sure that she has adequate levels of these vitamins in her blood. (Nelms
2016, p. 681).
 Reference Page
Belmonte, CA: Thomson Brooks/Cole, 2017. Nelms M., Medical Nutrition
Therapy A Case Study Approach 5th ed., Wadsworth/Thomson
Learning,
2017.

International Dietetic & Nutrition Terminology (IDNT): Reference

Manual. Standardized Language for Nutrition Care Process. Academy of
Nutrition and Dietetics.

Mahan, L.K., Escott-Stump, S. Krauses Food Nutrition & Diet Therapy,

13th OR 14th ed. Philadelphia, PA: W.B. Saunders Company, 2011.

Nelms M, Sucher K, Lacey, K., Habash, D., Roth S. Nutrition Therapy

and
Pathophysiology. 3rd ed.