SCTIMST Staff Nurse - 2015 (Set-A)
Medical & Surgical Nursing
Hard
A client who is sent home with an ileostomy requires dietary supplementation with?
Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)
Explanation
- An ileostomy involves diverting the small intestine to an opening in the abdomen, which bypasses the entire large intestine (colon).
- The colon's primary physiological function is the absorption of water and electrolytes, particularly sodium.
- Due to the colon bypass, ileostomy effluent (stool) is liquid and contains high amounts of sodium and water, leading to significant and continuous losses.
- To prevent dehydration and hyponatremia (low blood sodium), clients with an ileostomy require a higher intake of sodium in their diet.
Why Other Options Were Wrong
- Option A: High-fibre foods are poorly digested and can cause a food bolus obstruction (blockage) at the stoma site, especially in the early postoperative period.
- Option C: While some potassium is lost, the loss of sodium is far more clinically significant and pronounced. Routine potassium supplementation is not indicated.
- Option D: Vitamin B12 is absorbed in the terminal ileum. An ileostomy itself does not necessitate B12 supplementation unless the absorptive site was surgically removed.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Dietary management and supplementation for a client with an ileostomy as background academic context rather than a clinical decision trigger.
- Patient education is a critical nursing role. Nurses must teach clients with a new ileostomy to recognize the signs and symptoms of dehydration, such as increased thirst, dark urine, dizziness, and fatigue.
- Nurses should instruct patients to liberally salt their food and consider using oral rehydration solutions (ORS), which contain a balanced mix of salt, sugar, and water, especially during hot weather or illness.
- Monitoring stoma output is essential. An output consistently greater than 1.5 liters per day is considered a 'high-output stoma' and requires prompt medical evaluation to manage fluid and electrolyte imbalances.
How to Approach the Question
- First, identify the key term in the question: 'ileostomy'.
- Recall the anatomy and physiology related to an ileostomy. This procedure bypasses the large intestine (colon).
- Consider the primary function of the bypassed organ. The colon's main role is to absorb water and electrolytes, especially sodium.
- Deduce the direct consequence of this bypass: The body will lose large amounts of water and sodium.
- Evaluate the options based on this physiological consequence. The need to replace lost sodium makes 'Sodium' the most logical answer.
- Eliminate the other options by recalling their specific roles: Fibre can cause blockages, potassium loss is secondary, and Vitamin B12 absorption is site-specific (terminal ileum) and not always affected.
Concept Tested & Keywords
- Concept Tested: Dietary management and supplementation for a client with an ileostomy.
- Stem keywords: ileostomy, dietary supplementation
- Lead-in keywords: requires
- Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Question ID
QfTW-Q79AJGwvR0TmzFtif
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 45-47
E6 Nursing Fundamentals Taylor p. 636-638
Practise the full SCTIMST Staff Nurse - 2015 (Set-A)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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