A patient has become very depressed postoperatively after receiving a colostomy for GI cancer. He does not participate in his colostomy care or looks at the stoma. An appropriate nursing diagnosis for this situation is:
A. Ineffective Individual Coping
B. Knowledge Deficit
C. Impaired Adjustment
D. Anxiety
Correct Answer: A. Ineffective Individual Coping
The patient is dealing with a disturbance in self-concept and difficulty coping with the newly established stoma. Encourage the patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression and grief over a loss. Discuss daily “ups and downs” that can occur.
Option B: Provide opportunities for patient/SO to view and touch stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind the patient that it will take time to adjust, both physically and emotionally.
Option C: Although integration of stoma into body image can take months or even years, looking at the stoma and hearing comments (made in a normal, matter-of-fact manner) can help the patient with this acceptance. Touching stoma reassures patient/SO that it is not fragile and that slight movements of stoma actually reflect normal peristalsis.
Option D: Maintain a positive approach during care activities, avoiding expressions of disdain or revulsion. Do not take angry expressions of the patient and SO personally. A person who is living with an ostomy can be a good support system/role model. Helps reinforce teaching (shared experiences) and facilitates acceptance of change as the patient realizes “life does go on” and can be relatively normal.
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