A nurse is reinforcing teaching with a parent whose preschooler has sleep disturbances. Which of the following instructions should the nurse include?

An ascending colostomy is a surgical opening created in the ascending colon to divert fecal flow to an external pouch. Because it is located in the proximal large intestine, stool output is typically liquid to semi-liquid with high enzyme content. Postoperative teaching focuses on stoma care, expected stool characteristics, and recognition of complications such as ischemia. Monitoring stoma color is critical because it reflects blood supply and tissue viability.

Rationale:
A. Avoiding nuts is not a universal requirement for clients with a colostomy. While some foods may initially cause gas or blockage concerns, dietary restrictions are individualized rather than completely eliminating specific food groups. Clients are usually encouraged to gradually reintroduce foods while monitoring tolerance.

B. Irrigating the colostomy every day is not appropriate for an ascending colostomy. Irrigation is typically used for descending or sigmoid colostomies to regulate bowel emptying. An ascending colostomy produces frequent liquid output, making irrigation unnecessary and ineffective.

C. Expecting formed stool is incorrect for an ascending colostomy because stool at this level of the colon is still liquid to semi-liquid due to limited water reabsorption. Formed stool is more typical of descending or sigmoid colostomies where more water has been absorbed.

D. A stoma that appears purple is an abnormal finding indicating compromised blood flow or possible ischemia. A healthy stoma should be pink to red and moist. Any color change such as purple, dusky, or black should be reported immediately because it may indicate necrosis requiring urgent intervention.

Dysphagia is a swallowing disorder that affects a client’s ability to safely move food or liquids from the mouth to the stomach. It can result from neurological conditions, structural abnormalities, or muscle weakness and increases the risk of aspiration, choking, and malnutrition. Effective management requires specialized assessment of swallowing function and development of safe feeding strategies. Interprofessional collaboration is essential to ensure safe nutrition and prevent respiratory complications.

Rationale:
A. Occupational therapists focus on improving a client’s ability to perform activities of daily living such as dressing, grooming, and feeding independence. Although they may assist with adaptive feeding techniques, they do not primarily evaluate or treat swallowing disorders. Therefore, they are not the most appropriate referral for dysphagia.

B. Speech therapists are the appropriate specialists for clients with dysphagia because they assess and treat swallowing function. They evaluate oral and pharyngeal phases of swallowing, recommend safe food textures, and teach swallowing techniques to reduce aspiration risk. Their expertise directly addresses the physiological and safety concerns associated with dysphagia.

C. Respiratory therapists manage airway and breathing support, including oxygen therapy and mechanical ventilation. Although they may be involved if aspiration leads to respiratory complications, they do not assess or treat swallowing disorders directly. Their role is supportive rather than primary in dysphagia management.

D. Physical therapists focus on improving mobility, strength, balance, and physical function. They are not involved in the assessment or treatment of swallowing difficulties. Their interventions do not address the oral or pharyngeal mechanisms affected in dysphagia, making them an inappropriate referral for this condition.