A patient with an ileostomy may have a risk of?

AIIMS Delhi NO - 2018

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Delhi NO - 2018

Explanation

An ileostomy bypasses the large intestine, which is the primary site for water and electrolyte absorption, leading to a high risk of fluid and electrolyte imbalance.
The fecal output (effluent) from an ileostomy contains digestive enzymes that are caustic to the skin, creating a significant risk for peristomal skin breakdown and infection if not managed properly.
Living with an ostomy presents major psychosocial challenges, including altered body image, fear of odor, and social anxiety, which are critical aspects of patient care.
Since fluid imbalance, infection risk, and psychosocial distress are all well-documented and major risks for patients with an ileostomy, the most complete and correct option is the one that includes all these factors.

Option A: This option is a correct statement but incomplete. While fluid and electrolyte imbalance is a major risk, it is not the only risk associated with an ileostomy.
Option B: This option is a correct statement but incomplete. The risk of infection is significant, particularly for the peristomal skin, but other major risks also exist.
Option C: This option is a correct statement but incomplete. Psychosocial issues like fear and body image changes are crucial but are part of a broader set of risks.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risks and complications associated with an ileostomy to guide bedside assessment, documentation, and the next nursing action.
Comprehensive nursing care for an ileostomy patient must address physiological, skin integrity, and psychosocial needs simultaneously. A holistic approach prevents complications and improves quality of life.
Patient education is paramount. A nurse's role includes teaching stoma care, dietary and fluid management, and signs of complications, empowering the patient to manage their condition effectively at home.
What if? If the patient had a colostomy instead of an ileostomy, the risk of fluid and electrolyte imbalance would be significantly lower (especially for a sigmoid colostomy) because more of the colon remains to absorb water. The stool would also be more formed, and the risk of skin breakdown from enzymatic content would be less severe.

How to Approach the Question

First, identify the core subject of the question, which is 'ileostomy'.
Recall the physiological changes caused by an ileostomy: bypassing the large intestine.
Think through the consequences of this change. The large intestine absorbs water, so its bypass leads to fluid loss. The stoma is an opening with fecal content, creating an infection risk. The external bag and change in bodily function affect body image.
Evaluate each option. A) Fluid imbalance? Yes. B) Infection? Yes. C) Psychosocial issues? Yes.
Recognize that options A, B, and C are all correct and common risks.
When multiple options are correct and an 'All of the above' option exists, it is highly likely to be the correct answer. Select it as the most comprehensive choice.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 6 pp. 45-47, 44-46

E6 Nursing Fundamentals Taylor p. 636-638