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 end of the small intestine (ileum) through the abdominal wall to create a stoma.
• This procedure bypasses the entire large intestine (colon), which is the primary organ responsible for absorbing water from digested food.
• Consequently, the stool (effluent) from an ileostomy is liquid and continuous, leading to a high risk of dehydration and electrolyte imbalances.
• To counteract this significant fluid loss, clients must be taught to increase their daily fluid intake, typically to 2-2.5 liters or more, especially in hot weather or with increased perspiration.

Why Other Options Were Wrong

• Option B: Effluent from an ileostomy is continuous and contains digestive enzymes that are very irritating to the skin. The pouch must be worn at all times to collect drainage and protect the peristomal skin.
• Option C: A high-fiber diet is contraindicated, especially in the initial postoperative period (6-8 weeks), because it can cause a food blockage (bolus obstruction) at the stoma. Also, protein is essential for wound healing and recovery, so a low-protein diet is detrimental.
• Option D: Enteric-coated, sustained-release, or long-acting oral medications may not be fully absorbed due to the shortened transit time in the gastrointestinal tract. The medication may be expelled into the ostomy pouch before it has a chance to dissolve and take effect.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Discharge teaching and self-care management for a client with a new ileostomy to guide bedside assessment, documentation, and the next nursing action.
• Preventing dehydration is a primary nursing goal for patients with a new ileostomy. Dehydration and electrolyte imbalance are the most common reasons for hospital readmission in this population.
• Nurses must teach patients to recognize the signs of dehydration, such as increased thirst, dry mouth, decreased urine output, dark-colored urine, and fatigue.
• Patient education should also include monitoring the stoma output for consistency and volume. A sudden increase in watery output significantly raises the risk of dehydration.

How to Approach the Question

• First, identify the core subject of the question: discharge teaching for an ileostomy.
• Recall the pathophysiology of an ileostomy. The key fact is that the large intestine is bypassed.
• Consider the primary function of the large intestine, which is water absorption.
• Analyze how bypassing the large intestine would affect the body. The logical consequence is a loss of water, leading to liquid stool and a high risk of dehydration.
• Evaluate each option based on this physiological understanding.
• The option that directly addresses the primary complication (dehydration) is the most critical teaching point and therefore the correct answer.

Concept Tested & Keywords

• Concept Tested: Discharge teaching and self-care management for a client with a new ileostomy.
• Stem keywords: ileostomy, inflammatory bowel disease, discharge teachings
• Lead-in keywords: should teach on

Question ID

QwsRrNqKSx6RFwptO-UFX5

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 636-638

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