In caring for a newborn with a colostomy after anal agenesis, which nursing diagnosis has the highest priority?

• A. Potential for fluid volume deficit.
• B. Alteration in bowel elimination.
• C. Pain related to postoperative condition.
• D. Anxiety of parents related to newborn's condition.

Answer: (A)

Prioritizing fluid and electrolyte balance is essential in a newborn who has had a colostomy after anal agenesis because infants have limited reserves and rapid fluid turnover. The ostomy can lead to continuous fluid and electrolyte losses, and in a neonate even small losses can rapidly lead to dehydration and decreased perfusion. Protecting the infant’s circulatory status by preventing fluid volume deficit is the most immediate and life-threatening concern, so monitoring intake and output, skin condition, mucous membranes, fontanelles, and urine output becomes the top nursing priority.

Once fluid status is stabilized and monitored, attention can shift to other needs such as establishing and recording bowel elimination patterns via the stoma, managing postoperative pain, and supporting the parents’ emotional response. The latter remain important but do not pose the same acute risk to the infant’s survival as maintaining adequate circulating volume.