The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply.
A. “If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
B. “I can place an aspirin tablet in my pouch to decrease odor.”
C. “I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
D. “I must use a skin barrier to protect my skin from urine.”
E. “I should empty my ostomy pouch of urine when it is full.”
Correct Answer: C & D
The client with an ileal conduit must learn self-care activities related to the care of the stoma and ostomy appliances. The client should be taught to increase fluid intake to about 3,000 ml per day and should not limit intake. The ostomy appliance should be changed approximately every 3 to 7 days and whenever a leak develops. A skin barrier is essential to protecting the skin from the irritation of the urine.
Option A: Adequate fluid intake helps to flush mucus from the ileal conduit. Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly. Provides direct indicators of fluid balance. Greatest fluid losses occur with an ileostomy, but they generally do not exceed 500–800 mL/day.
Option B: An aspirin should not be used as a method of odor control because it can be an irritant to the stoma and lead to ulceration. Apply corticosteroid aerosol spray and prescribed antifungal powder as indicated. Assists in healing if peristomal irritation persists and/or fungal infection develops. Note: These products can have potent side effects and should be used sparingly.
Option C: Empty, irrigate, and cleanse ostomy pouch on a routine basis, using appropriate equipment. Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution not only removes bacteria and odor-causing stool and flatus but also deodorizes the pouch.
Option D: Apply appropriate skin barrier: hydrocolloid wafer, karaya gum, extended-wear skin barrier, or similar products. Protects skin from pouch adhesive, enhances adhesiveness of pouch, and facilitates removal of pouch when necessary.
Option E: The ostomy pouch should be emptied when it is one-third to one-half full to prevent the weight from pulling the appliance away from the skin. Use a transparent, odor-proof drainable pouch. A transparent appliance during the first 4–6 wk allows easy observation of stoma without the necessity of removing pouch/irritating skin.
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