A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client’s pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should Nurse Kaye conclude?
A. The skin wasn’t lubricated before the pouch was applied.
B. The pouch faceplate doesn’t fit the stoma.
C. A skin barrier was applied properly.
D. Stoma dilation wasn’t performed.
Correct Answer: B. The pouch faceplate doesn’t fit the stoma.
If the pouch faceplate doesn’t fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. The hole should fit snugly around the stoma without any gaps. Make sure that the hole is not too small either so that it doesn’t dig into the stoma and cause any cuts or abrasions that could bleed.
Option A: A lubricant shouldn’t be used because it would prevent the pouch from adhering to the skin. Most suppliers will include a stoma measuring guide and templates for the client to accurately cut the shape.
Option C: When properly applied, a skin barrier prevents skin excoriation. A skin barrier adheres to the peristomal (around the stoma) skin, helping protect the skin from stoma output, and attaching the pouch to the body.
Option D: Stoma dilation isn’t performed with an ileal conduit, although it may be done with a colostomy if ordered. Stenosis in the subcutaneous aspect is usually treated with dilation initially; however, multiple sessions are usually required and tissue trauma during mechanical dilation invokes fibrosis which, in turn, results in further stenosis.
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