NU142 Unit 2 Case Study Analysis Example

Two Liters a Day Out of the Stoma: A Case Study Analysis of High Ileostomy Output, Dehydration and Falling Potassium and Magnesium in a Composite 36-Year-Old Woman Ten Days After Surgery for Ulcerative Colitis

[Student Name]

Purdue University Global

NU142: Medical-Surgical Nursing I

Unit 2 Case Study Analysis

[Instructor Name]

[Date]

The patient is composite; volumes and values are bracketed where illustrative, and treatment decisions belong to the surgical team.

The Case

[Ms. T.], a composite 36-year-old graphic designer, had her colon removed and an end ileostomy created because her ulcerative colitis had stopped responding to every medicine tried. She went home on day six. Four days later she returns with dizziness on standing, cramping in her legs and very little urine. She has been drinking plain water and sports drinks "all day" because she was told to stay hydrated. Her stoma output, measured in the emergency department, is thin and watery, about [2,200] mL over the past 24 hours by her estimate. Heart rate [112] lying, [134] standing; blood pressure [102/64]. Creatinine [1.8] mg/dL, up from [0.7] at discharge. Sodium [131], potassium [3.0], magnesium [1.3] mg/dL. Urine output [240] mL in 12 hours.

Why an Ileostomy Loses So Much

The colon normally absorbs most of the water and much of the sodium that reaches it, turning liquid small-bowel contents into formed stool. Without the colon, those contents leave through the stoma while still liquid. An ileostomy typically puts out [800] to [1,200] mL a day once it settles; output above about [1,500] to [2,000] mL a day is considered high and can quickly cause dehydration and kidney injury. Dehydration is among the most common reasons for readmission after an ileostomy is created (Paquette et al., 2013).

She drank more water to keep up, and the plain water itself made the losses worse, because it pulls sodium into the gut and out through the stoma.

Plain water and many sports drinks contain little sodium. When large amounts of low-sodium fluid enter the small bowel, sodium moves from the blood into the gut to balance concentrations, and more fluid and sodium leave through the stoma. Drinking more of the wrong fluid can increase output.

Working the Numbers

Her intake over 24 hours was about [2,500] mL, mostly water. Her output was about [2,200] mL from the stoma and [480] mL of urine, plus estimated insensible losses of [600] to [800] mL, which are not measured but must be counted (Potter et al., 2023). Total out is roughly [3,300] to [3,500] mL against [2,500] mL in, a deficit of about [800] to [1,000] mL a day on top of what she had already lost. Her urine output, about [20] mL an hour, is below the usual minimum for her weight of [64] kg, about [32] mL an hour.

Each Electrolyte Change

Sodium is low because sodium-rich stoma fluid is lost and replaced with water. Potassium is low because small-bowel fluid contains potassium and because dehydration triggers aldosterone, which makes the kidney excrete potassium to retain sodium. Magnesium is low because it is absorbed in the small bowel and lost with high output, and low magnesium makes potassium harder to correct, since the kidney keeps wasting potassium until magnesium is replaced. The rising creatinine reflects reduced kidney blood flow from volume depletion, a prerenal kidney injury (Harding et al., 2023).

Nursing Priorities in Sequence

1. Restore circulating volume: IV fluids as ordered, with hourly urine output and orthostatic vital signs. Her standing heart rate and low urine output show this is the immediate threat to her kidneys.

2. Replace electrolytes safely: potassium and magnesium as ordered, with cardiac monitoring because low potassium raises rhythm risk; magnesium replaced alongside potassium.

3. Measure and reduce stoma output: empty and measure the pouch each time, record output against intake, and give antimotility medicine if prescribed.

4. Teach before discharge: an oral rehydration solution with adequate sodium instead of plain water, limiting low-salt fluids, eating starchy foods that thicken output, recognizing early dehydration and measuring output at home.

Why the Discharge Teaching Failed

Her first discharge teaching told her to drink plenty of fluids, which is common advice after surgery but incomplete after an ileostomy. She followed it exactly, with water and low-sodium sports drinks, and the advice itself contributed to her readmission. The revised teaching names the kind of fluid as well as the amount, gives her a written recipe for an oral rehydration drink, sets a daily output target she can measure, and lists the signs that mean she should call before she becomes dizzy: output over [1,500] mL in a day, dark or scant urine, leg cramps or lightheadedness on standing. She practices measuring her pouch output with a marked container before she leaves, so the number she reports at home means the same thing the nurses measured.

Evaluation

After 24 hours of IV fluids and replacement, her standing heart rate was [96], urine output [45] mL an hour, creatinine [1.1], potassium [3.8] and magnesium [1.9]. Stoma output fell to [1,300] mL with loperamide and dietary changes. She was able to explain why plain water had worsened her losses.

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Paquette, I. M., Solan, P., Rafferty, J. F., Ferguson, M. A., & Davis, B. R. (2013). Readmission for dehydration or renal failure after ileostomy creation. Diseases of the Colon & Rectum, 56(8), 974-979. https://doi.org/10.1097/DCR.0b013e31828d02ba

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.