Question

The nurse is caring for a client with an ileostomy. The nurse should pay careful attention to care around the stoma because: A. Digestive enzymes cause skin breakdown. B. Stools are less watery and contain more solid matter. C. The stoma will heal more slowly than expected. D. It is difficult to fit the appliance to the stoma site.

Short answer

Answer: The primary reason proper care around the stoma for a client with an ileostomy is crucial is that digestive enzymes in the ileostomy output can cause skin breakdown. Proper care helps to prevent skin irritation, infection, and other potential complications.

Step-by-step solution

Understanding the ileostomy and stoma

An ileostomy is a surgical procedure that creates an opening (stoma) in the abdomen for the small intestine (ileum) to pass waste outside of the body. The stoma is a small, pinkish-red, and moist opening which is created by bringing the end of the small intestine through an incision in the abdominal wall. Consequently, the care around the stoma is crucial to prevent potential complications such as infection, skin irritation, or breakdown.

Analyzing answer choice A

Digestive enzymes cause skin breakdown. This answer choice is accurate because the ileostomy bypasses the large intestine, where most of the water is absorbed back into the body. As a result, the ostomy output (stool) is mostly liquid and contains digestive enzymes that can be highly irritating to the skin around the stoma. If not properly managed, this can lead to skin breakdown, making answer choice A the correct option.

Analyzing answer choice B

Stools are less watery and contain more solid matter. This statement is actually the opposite of the reality of an ileostomy. As mentioned in the explanation of answer choice A, the output from an ileostomy tends to be more liquid as it bypasses the large intestine, where water absorption takes place. Therefore, answer choice B is incorrect.

Analyzing answer choice C

The stoma will heal more slowly than expected. This statement is not necessarily true, as the healing process of the stoma depends on individual factors such as overall health, nutrition, and post-operative care. While some stomas may take longer to heal than others, this is not directly related to ileostomy care. Thus, answer choice C is not the best answer.

Analyzing answer choice D

It is difficult to fit the appliance to the stoma site. While it can be true that finding the right fit for an ileostomy appliance can be challenging, this does not necessarily relate directly to the care needed around the stoma to prevent complications like skin irritation or infection. Proper care of the stoma includes cleaning the skin, inspecting for changes, and using appropriate ostomy supplies. Therefore, answer choice D is not the best response to the question.

Conclusion

The correct answer choice for the given exercise is A: Digestive enzymes cause skin breakdown. The reasoning for this answer lies in the fact that the output from an ileostomy is mostly liquid and contains digestive enzymes that can be irritating to the skin around the stoma. Proper care is crucial in preventing skin breakdown and promoting overall stoma health.

Key concepts

Stoma Management

Stoma management is all about keeping the area around the stoma clean and healthy. This helps prevent potential complications such as infections or skin irritation. A stoma is a tiny opening created during an ileostomy surgery, allowing waste to leave the body through the abdomen. Here are some tips for managing a stoma effectively:

• Regular cleansing: Wash the stoma area gently with warm water. Avoid using harsh soaps or cleansers.
• Pat drying: Always pat the skin dry instead of rubbing it.
• Correct appliance fitting: Make sure your ileostomy appliance fits well and does not cause leaks.
• Frequent changes: Change your appliance regularly to avoid skin irritation.

Remember, the goal is to ensure that the stoma functions well while the skin around it stays intact and healthy.

Skin Integrity

Maintaining skin integrity is essential when caring for an ileostomy. The skin around the stoma can become irritated due to continuous exposure to the digestive enzymes present in the output. To protect the skin:

• Use skin barriers like creams or powders to protect against enzymes.
• Check for redness or irritation frequently.
• Be mindful of any discomfort or itching – it's a sign to check the skin.
• Consider using a barrier ring for added protection if needed.

Keeping the skin healthy minimizes the risk of complications and ensures comfort for the ileostomy patient.

Digestive Enzymes

Digestive enzymes play a significant role in the complications associated with ileostomy care. These enzymes are present in the intestinal output, making it more caustic to the skin around the stoma. Digestive enzymes in the small bowel:

• Help break down food for nutrient absorption.
• Are not absorbed back into the body due to bypassing the large intestine.

This lack of absorption results in a liquid output containing active enzymes, which can irritate and break down the skin. Thus, managing digestive enzymes' impact is crucial for maintaining skin integrity and stoma health.

Post-Operative Care

Post-operative care is crucial following ileostomy surgery. It involves taking care of the surgical site to ensure proper healing and stoma function. Key aspects of post-operative care:

• Monitor the stoma size, color, and output regularly.
• Seek help if there is significant change in the stoma's appearance.
• Stay hydrated, as the ileostomy causes increased fluid loss.
• Follow a balanced diet to promote healing and accommodate digestive changes.

By focusing on these areas, patients can ensure healthy recovery and adapt to life with an ileostomy more comfortably.