Tuesday, January 9, 2024

A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion.. The pouch faceplate doesn’t fit the stoma

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 Katrina 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.

Answer B.

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. A lubricant shouldn’t be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn’t performed with an ileal conduit, although it may be done with a colostomy if ordered.

Nurse Katrina should conclude that b. the pouch faceplate doesn't fit the stoma is the most likely explanation for the red, weeping, and painful area around the client's stoma.

Here's why:
Red, weeping, and painful skin are common symptoms of peristomal skin irritation, which can occur due to several factors, including:

- Improper pouch fit:

A poorly fitting faceplate can cause leakage of urine onto the skin, leading to irritation and inflammation. This is especially likely if the stoma is irregular or has changed size since the pouch was applied.

- Skin barrier issues:

While not the most likely cause in this case, an improperly applied skin barrier could also contribute to irritation.

- Lubrication:

While lack of lubrication can cause discomfort, it's less likely to cause the specific symptoms of redness, weeping, and pain.

- Stoma dilation:

This procedure is typically performed immediately after stoma creation and wouldn't be relevant to the current situation.

Therefore, considering the specific symptoms and the context of a recently created ileal conduit, a poorly fitting pouch faceplate is the most likely culprit.

Additional Points:

Here are some additional points to consider:
  • Nurse Katrina should assess the pouch and stoma carefully to determine the specific nature of the problem. Is the faceplate too small, too large, or the wrong shape?
  • She should also inquire about the client's recent activities and any changes in their urine output or consistency, which could contribute to leakage and irritation.
  • Based on her assessment, Nurse Katrina should recommend appropriate interventions, such as changing the pouch to a better-fitting one, using a different type of skin barrier, or applying a protective barrier to the irritated skin.

It's important to remember that every client is unique and the cause of peristomal skin irritation can vary. A thorough assessment and individualized care plan are essential for managing this common complication of ostomy surgery.