The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate post-op period for which of the following most frequent complications of this type of surgery?
A. Intestinal obstruction
B. Fluid and electrolyte imbalance
C. Malabsorption of fat
D. Folate deficiency
Correct Answer: B. Fluid and electrolyte imbalance
A major complication that occurs most frequently following an ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from happening. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Monitor I&O carefully, measure liquid stool. Weigh regularly. This provides direct indicators of fluid balance. Greatest fluid losses occur with an ileostomy, but they generally do not exceed 500–800 mL/day.
Option A: Intestinal obstruction is a less frequent complication. Small bowel obstruction is a recognized complication of ileostomy. Small bowel obstruction may occur because of too small trephine in the anterior abdominal wall, a twisted loop, small bowel adhesions in the area around the ileostomy, intraperitoneal adhesions, or an acute parastomal hernia.
Option C: Fat malabsorption is a complication that could occur later in the postoperative period. Suggest the patient with ileostomy limit prunes, dates, stewed apricots, strawberries, grapes, bananas, cabbage family, beans, and avoid foods high in cellulose, e.g., peanuts. These products increase ileal effluent. Digestion of cellulose requires colon bacteria that are no longer present.
Option D: Folate deficiency is a complication that could occur later in the postoperative period. Vitamin B12 plays an important role in keeping the brain and nervous system healthy. This decrease is thought to occur because the part of the intestine removed during the procedure is responsible for absorbing some vitamin B12 from the food you eat.
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