During a pouch change for a client with an ileal conduit, the stoma area is red, weeping, and painful. What should the nurse conclude?

During a pouch change for a client with an ileal conduit, the stoma area is red, weeping, and painful. What should the nurse conclude?

• A. The pouch faceplate doesn't fit the stoma.
• B. The stoma is infected.
• C. The appliance is the wrong size for the leg.
• D. The skin barrier is too dry.

Answer: (A)

Irritation around the stoma from leakage is the key idea here. When the pouch faceplate doesn’t fit snugly around the stoma, urine or intestinal effluent can seep under the barrier and contact the surrounding skin. This moisture causes skin maceration, redness, and pain—the peristomal skin becomes irritated and may weep as it tries to heal. The appliance needs to be sized and fit correctly to create a proper seal around the stoma, protecting the skin. An infection would usually bring additional signs such as fever, spreading redness, warmth, or purulent drainage, not just a red, weeping area. The size of the appliance for the leg isn’t related to peristomal skin irritation, and a barrier that’s too dry would more likely cause cracking or flaking rather than active weeping. So the best conclusion is that the pouch faceplate doesn’t fit the stoma correctly, leading to leakage and skin irritation.

Irritation around the stoma from leakage is the key idea here. When the pouch faceplate doesn’t fit snugly around the stoma, urine or intestinal effluent can seep under the barrier and contact the surrounding skin. This moisture causes skin maceration, redness, and pain—the peristomal skin becomes irritated and may weep as it tries to heal. The appliance needs to be sized and fit correctly to create a proper seal around the stoma, protecting the skin.

An infection would usually bring additional signs such as fever, spreading redness, warmth, or purulent drainage, not just a red, weeping area. The size of the appliance for the leg isn’t related to peristomal skin irritation, and a barrier that’s too dry would more likely cause cracking or flaking rather than active weeping. So the best conclusion is that the pouch faceplate doesn’t fit the stoma correctly, leading to leakage and skin irritation.