Purple color of the stoma indicates decreased perfusion to the intestines, which could be caused by systemic hypotension; urine output indicates the adequacy of end-organ perfusion. Bowel sounds are unlikely to be present 48 hours after major abdominal surgery. The heart rate can be variable for many different reasons; the urine output is a more helpful assessment. If the urine output is determined to be adequate and not reflective of systemic hypotension and hypoperfusion, then the ostomy appliance should be assessed to ensure it isn’t too tight.