Playing on the phone while the nurse assesses the bag indicates a refusal to look at the bag, which is a sign the patient is experiencing an alteration in body image. Asking if the ostomy will always look bright red and bloody indicates an engagement in learning about the change. Stating the ostomy output smells awful is a normal reaction and does not indicate an alteration in body image. In the days immediately after the surgery, requesting help to empty and manage the ileostomy bag is normal while the patient is learning this new reality.