A 32-year-old patient experiences an intestinal perforation and requires emergency surgery
The surgeon first meets the patient just before anesthesia is to be given and explains that peritonitis and intestinal inflammation may make a colostomy necessary. The patient is still quite groggy when stepped down to a postoperative unit and does not yet know that he does have a colostomy. Which initial response(s) should his nurse anticipate when the patient discovers that this procedure has been necessary? Select all that apply. a. Distress that he has been disfigured and will be repugnant to others
b. Thankfulness that the surgery was successful and that he will live
c. Concerns about how he will do all the things he is used to doing
d. Anger that this has happened to him and that it has ruined his life
e. Depression related to changes in body image and perceived losses
f. Curiosity about how colostomies work and how one cares for them
A, C, D, E
This patient had no time to prepare emotionally or intellectually for the significant changes in function and appearance that follow a colostomy. It is likely that he will experience a wide range of strong emotional responses: fear about being repugnant to others or being rejected, anger that this has happened to him and changed his life for the worse, concerns about his appearance and how (or if) he will be able do the things he is used to doing, and depression as the breadth and gravity of the changes and possible losses he is facing begin to register. In time, it is likely that he will adjust to the changes in appearance and function, finding ways to adapt so the great majority of his previous activities will remain possible. At this stage, however, he is likely to be quite distressed emotionally. It is unlikely that thankfulness or curiosity will be major or immediate responses relative to these stronger emotions.
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