Page 1326 - Saunders Comprehensive Review For NCLEX-RN

▪ Hold a rolled gauze pad against the stoma to collect and absorb urine during the
procedure.
▪ Cleanse the skin around the stoma and under the drainage bag with mild
nonresidue soap and water.
▪ Inspect the skin for excoriation, and instruct the client to prevent urine from
coming into contact with the skin.
▪ After the skin is dry, apply skin adhesive around the appliance.
▪ Instruct the client to cut the stoma opening of the skin barrier just large enough
to fit over the stoma (no more than 3 mm larger than the stoma).
▪ Instruct the client that the stoma will begin to shrink, requiring a smaller stoma
opening on the skin barrier.
▪ Apply the skin barrier before attaching the pouch or face plate.
▪ Place the appliance over the stoma and secure in place.
▪ Encourage self-care; teach the client to use a mirror.
▪ Instruct the client that the pouch may be drained by a bedside bag or leg bag,
especially at night.
▪ Instruct the client to empty the urinary collection bag when it is one-third full to
prevent pulling of the appliance and leakage.
▪ Instruct the client to check the appliance seal if perspiring occurs.
▪ Instruct the client to leave the urinary pouch in place as long as it is not leaking
and to change it every 5 to 7 days.
▪ During appliance changes, leave the skin open to air for as long as possible.
▪ Use a non–karaya product, because urine erodes karaya.
▪ To control odor, instruct the client to drink adequate fluids, wash the appliance
thoroughly with soap and lukewarm water, and soak the collection pouch in
dilute white vinegar for 20 to 30 minutes; a special deodorant tablet can also be
placed into the pouch while it is being worn.
▪ Instruct the client who takes baths to keep the level of the water below the stoma
and to avoid oily soaps.
▪ If the client plans to shower, instruct the client to direct the flow of water away
from the stoma.

Box 44-19

Self-Irrigation and Catheterization of Stoma

Irrigation

▪ Instruct the client to wash hands and use clean technique.
▪ Instruct the client to use a catheter and syringe, instill 60 mL of normal saline or
water into the reservoir, and aspirate gently or allow to drain.
▪ Instruct the client to irrigate until the drainage remains free of mucus but to be
careful not to overirrigate.

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