Situation: A 66-year-old man with adenocarcinoma of the lower rectum undergoes abdominoperineal resection with a permanent sigmoid colostomy. He has no other medical conditions. On postoperative day 6, the nurse evaluates the plan of care for preventing peristomal skin damage. Which finding BEST shows that this goal is being met?

A goal is evaluated by an outcome in the client, not by the care activities performed. Intact peristomal skin without redness directly shows that skin damage is being prevented. Emptying the pouch and changing the barrier are interventions, and looking at the stoma relates to a body image goal.

Understanding the Question

The question asks which finding best shows that the goal of preventing peristomal skin damage is being met. The key word is best, which means you must select the option that most directly reflects the client outcome, not merely the care delivered.

A goal is evaluated by an outcome in the client, not by the care activities performed. This principle is central to the nursing process. Interventions such as emptying a pouch or changing a barrier are actions the nurse takes. They may be appropriate, but they do not prove that the skin is actually healthy. The only option that directly measures the condition of the peristomal skin is the finding that the skin is intact and without redness.

Why Option 2 Is Correct

Peristomal skin damage most commonly presents as irritant contact dermatitis caused by exposure to effluent from the stoma ^[3]. When the pouching system fits properly and the skin barrier remains intact, the peristomal skin stays dry and free from chemical irritation. Therefore, intact peristomal skin without redness is the direct, observable client outcome that confirms the skin has not been damaged. This aligns with the WOCN Society’s emphasis on assessing and promoting peristomal skin health as a primary goal of ostomy care ^[2].

Why the Other Options Are Incorrect

Option	Category	Why It Does Not Best Show the Goal Is Met
1. The pouch was emptied four times during the shift	Nursing intervention	Emptying the pouch prevents leakage and reduces skin exposure, but it is an action. The frequency of emptying does not prove the skin is currently undamaged. A pouch could be emptied frequently yet still leak, causing skin breakdown.
3. The skin barrier has been replaced every day	Nursing intervention	Routine barrier replacement is a preventive measure. However, changing the barrier too frequently can itself traumatize the peristomal skin. The outcome of interest is the skin condition, not how often the barrier was changed.
4. The client looks at the stoma during pouch changes	Psychosocial outcome	This finding relates to body image adjustment and acceptance of the stoma, which is a different nursing goal. It does not provide any information about the physical integrity of the peristomal skin.

Clinical Application and Exam Focus

In ostomy care, peristomal skin complications are among the most common and avoidable problems for patients . The WOCN Society identifies peristomal skin health as a distinct outcome requiring regular assessment ^[2]. When evaluating a plan of care, you must always ask: “What is the evidence in the client that the problem is resolved or prevented?” For skin integrity, that evidence is visual inspection showing intact, non-erythematous skin.

Watch out! Do not confuse interventions (what the nurse does) with outcomes (what happens to the client). Options 1 and 3 are interventions. Option 4 is an outcome for a different nursing diagnosis.

Key point! The correct answer for any “goal is being met” question must reflect a measurable change in the client’s condition, not the completion of a task. Intact skin without redness is the only option that directly measures the absence of skin damage.