A nurse is monitoring a patient with a colostomy. Which observation requires immediate attention?

RRB Nsg. Superintendent-2026 (Shift -2nd)

Medical & Surgical Nursing

Medium

Appeared in: RRB Nsg. Superintendent-2026 (Shift -2nd)

Explanation

A dark and bluish stoma is a critical finding that signals compromised blood circulation to the stoma, a condition known as ischemia.
Ischemia can rapidly progress to necrosis (tissue death) if not addressed immediately.
This is considered a surgical emergency requiring prompt notification of the healthcare provider to salvage the stoma.
A healthy, well-perfused stoma should always be pink or red and moist.

Option B: This is a normal and expected finding for a colostomy located in the descending or sigmoid colon, as water has been absorbed from the stool.
Option C: A temporary decrease or absence of bowel output is common in the immediate postoperative period due to paralytic ileus caused by anesthesia and bowel manipulation during surgery.
Option D: This describes a healthy, viable stoma with adequate blood supply. It is the desired finding and does not require any immediate action beyond routine care.

Visual 1: Comparative Chart - An infographic showing images of a healthy pink stoma, a pale stoma (indicating anemia), and a dark/bluish/black stoma (indicating ischemia/necrosis) with corresponding nursing actions.
Visual 2: Diagram - A diagram of the large intestine showing the locations for ascending, transverse, descending, and sigmoid colostomies and how the location affects stool consistency.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of colostomy stoma and identification of emergent complications to guide bedside assessment, documentation, and the next nursing action.
Regular and thorough stoma assessment is a critical nursing responsibility. The color, size, shape, and surrounding skin must be checked with every pouch change.
Patient education is vital. Patients and their families must be taught how to assess the stoma and recognize signs of complications, empowering them to seek timely medical help.
What if? If the stoma appears pale, it could indicate anemia. The nurse should assess the patient's hemoglobin and hematocrit levels, check for other signs of anemia (like fatigue or shortness of breath), and report the findings to the provider. While not an immediate emergency like a blue stoma, it still requires follow-up.

How to Approach the Question

First, understand the core of the question: it asks to identify a sign that requires immediate attention, indicating a priority or emergency situation.
Second, recall the characteristics of a healthy colostomy stoma. The baseline is pink/red and moist, signifying good blood flow.
Third, evaluate each option against this baseline. 'Stoma is moist and pink' is the normal baseline, so it's incorrect.
Fourth, consider the normal functioning of a colostomy. 'Formed, brown effluent' is normal for a distal colostomy, and 'temporary decrease in output' is expected post-op. These are not emergencies.
Fifth, analyze the remaining option. 'Stoma appears dark and bluish' deviates significantly from the healthy baseline and indicates a lack of blood supply (ischemia), which is a time-sensitive emergency. This makes it the correct answer.

Concept Tested & Keywords

Concept Tested: Assessment of colostomy stoma and identification of emergent complications.
Stem keywords: colostomy, monitoring, observation, immediate attention
Lead-in keywords: requires immediate attention
Negative lead-in flag: false

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