# A nurse is completing discharge teaching for a 62-year-old client on postoperative day 5 after creation of a sigmoid colostomy. The stoma is moist, red, and edematous, measuring 38 mm today, and the output is soft and pasty. The client plans to order barrier wafers precut to 38 mm for home use. Which instructions should the nurse include? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617293&lang=en  
> language: en  
> subject: Elimination  
> category: BCC

## Question

A nurse is completing discharge teaching for a 62-year-old client on postoperative day 5 after creation of a sigmoid colostomy. The stoma is moist, red, and edematous, measuring 38 mm today, and the output is soft and pasty. The client plans to order barrier wafers precut to 38 mm for home use. Which instructions should the nurse include? Select all that apply.

1

Order wafers precut to 38 mm since that is the stoma size measured before discharge

2

Expect the stool to become more formed as the diet advances over the coming weeks

3

Measure the stoma at each pouch change and resize the wafer as the stoma shrinks

4

Change the whole pouching system every day to keep the skin under the wafer clean

5

Call the ostomy nurse if the skin under the wafer stays raw and weeping for days

6

Call the surgeon if the stoma bleeds a small amount when it is wiped during cleaning

## Explanation

A new stoma is edematous and shrinks over about 6 to 8 weeks, so it is re-measured at each change and the wafer opening adjusted; precut wafers at today's size will soon leave exposed skin. Sigmoid colostomy output becomes more formed as the diet advances. Persistent raw, weeping peristomal skin needs ostomy nurse follow-up, whereas slight bleeding when the stoma is wiped is expected because the mucosa is vascular, and daily full changes strip the skin.

## In-depth explanation

Quick answer
Re-measure the edematous stoma, expect firmer stool, and report persistently raw peristomal skin.

Why this is correct
The scenario details drive the answers: postoperative day 5 and an edematous 38 mm stoma mean the size will fall over the coming weeks, so the client's plan to lock in precut 38 mm wafers must be corrected. A sigmoid colostomy is in the distal colon, where water is reabsorbed, so pasty output now will usually become formed. Raw, weeping skin under the wafer signals leakage or a poor fit and needs expert assessment.

Easy analogy or mental picture
A new stoma is like a sprained ankle: swollen at first and shrinking back over weeks, so the shoe (wafer) size has to change with it.

Memory hook
New stoma shrinks: measure every change for 6 to 8 weeks.

NCLEX decision rule
Teaching for a new ostomy must anticipate expected changes over time (stoma size, output consistency) and separate expected findings from those needing follow-up.

Why the other choices are wrong
Ordering precut wafers at 38 mm is tempting because it uses an accurate current measurement, but the stoma will shrink and the gap will expose skin to stool. Daily full changes sound cleaner, but frequent adhesive removal damages the peristomal skin; routine changes are every 3 to 7 days or when leaking. Slight bleeding on wiping looks alarming, but stoma mucosa is highly vascular and minor bleeding is expected; persistent bleeding or a dusky color would need reporting.

References
1United Ostomy Associations of America (UOAA)Colostomy self-care, stoma measurement, and peristomal skin care
2Wound, Ostomy and Continence Nurses Society (WOCN)Ostomy care standards and specialist follow-up for peristomal skin complications

## Clinical scenario

Scenario
Postoperative day 5 after sigmoid colostomy; stoma edematous at 38 mm, soft pasty output. Client plans to order precut wafers at today's size.

## Key concepts

- **Stoma edema** — Postoperative swelling of the stoma that gradually decreases over about 6 to 8 weeks.
- **Peristomal skin** — The skin surrounding the stoma that is covered by the barrier wafer.
- **Sigmoid colostomy** — A colostomy in the descending-sigmoid colon, which usually produces formed stool.

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