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. B. is a 22-year-old woman who was admitted and had surgery 3 days ago for a colectomy and colostomy due to inflammation and a perforated bowel. She has a history of Crohn’s disease. She has lost significant weight. Presently she is 5’2” and weighs 89 pounds. She has a surgical drain that is going to be removed today. Her vital signs are temperature 99.0 F orally, heart rate is 98 and regular, respirations are 22 and unlabored, and blood pressure is 118/72. She rates her pain a “4” on the numeric scale.

Then surgeon has just removed the surgical drain and you stay with the patient to complete your assessment. Her colostomy is intact and draining watery brownish color feces. Patient is alert and oriented to person, place, time and situation. She is able to follow the conversation, but you notice she is not making eye contact with you. You ask her what is wrong and she replies “How am I going to get a boyfriend with this on me? How am I going to have children? I look really sexy now.” She has tears in her eyes.

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