A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teachings for this client, the nurse should teach on?

1. A

   Increasing fluid intake to prevent dehydration

2. B

   Wearing an appliance pouch only at bedtime

3. C

   Consuming a low-protein, high fiber diet

4. D

   Taking only enteric coated medications

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

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• An ileostomy involves bringing the ileum (part of the small intestine) to the surface of the abdomen, bypassing the entire large intestine.
• The large intestine's primary function is to absorb water and electrolytes from stool.
• Without the large intestine, the stool (effluent) is liquid, high in volume, and continuous.
• This leads to a significant risk of dehydration and electrolyte imbalances, making increased fluid intake a critical teaching point.

Why Other Options Were Wrong

• Option B: Ileostomy output is continuous and unpredictable. The pouch must be worn at all times to collect the liquid stool and protect the peristomal skin from irritation caused by digestive enzymes.
• Option C: A high-fiber diet is contraindicated in the initial postoperative period (6-8 weeks) as it can cause a food blockage at the stoma. A low-fiber (low-residue) diet is recommended. Additionally, adequate protein is essential for wound healing after surgery, so a low-protein diet would be detrimental.
• Option D: Enteric-coated medications are designed to bypass the stomach and dissolve in the more alkaline environment of the small or large intestine. With an ileostomy, the shortened bowel transit time means these medications may be expelled before they can be fully dissolved and absorbed, making them ineffective.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Discharge teaching for a client with a new ileostomy to guide bedside assessment, documentation, and the next nursing action.
• A primary nursing role is to educate the patient on recognizing the signs and symptoms of dehydration, such as thirst, dry mouth, dark-colored urine, fatigue, and dizziness.
• Nurses must monitor fluid intake and output, as well as serum electrolyte levels (especially sodium and potassium), to prevent life-threatening imbalances in the postoperative period.
• What if? If the client had a sigmoid colostomy instead of an ileostomy, the teaching priority would shift. The stool would be more formed, and the risk of dehydration would be much lower. The focus would be on dietary management to maintain stool consistency and establishing a regular bowel routine, possibly with colostomy irrigation.

How to Approach the Question

• First, identify the key procedure in the question: an ileostomy.
• Recall the major physiological change caused by an ileostomy: the entire large intestine is bypassed.
• Consider the primary function of the bypassed organ (the large intestine), which is water and electrolyte absorption.
• Deduce the main consequence of this change: stool will be liquid and continuous, leading to a high risk of dehydration.
• Evaluate each option based on this primary consequence. The option that directly addresses the most critical risk (dehydration) is the correct answer.
• Eliminate other options by cross-referencing them with known ileostomy care principles, such as the need for continuous pouching, a low-fiber initial diet, and avoidance of certain medication formulations.

Concept Tested & Keywords

• Concept Tested: Discharge teaching for a client with a new ileostomy.
• Stem keywords: ileostomy, inflammatory bowel disease, discharge teachings
• Lead-in keywords: teach on
• Negative lead-in flag: false

Question ID

QwsRrNqKSx6RFwptO-UFX5

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor pp. 636-638, 635-637

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 44-46