# Situation: A 45-year-old woman weighing 60 kg had a total colectomy with an end ileostomy 5 days ago. Her stoma is pink, moist, and slightly swollen. The nurse is preparing her for discharge. Which statement shows that she understood the discharge teaching?

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> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 45-year-old woman weighing 60 kg had a total colectomy with an end ileostomy 5 days ago. Her stoma is pink, moist, and slightly swollen. The nurse is preparing her for discharge.

Which statement shows that she understood the discharge teaching?

## 보기

1. "I will rub moisturizing lotion around the stoma before the wafer goes on."
2. "I will leave each wafer on for 2 weeks, even if it itches under it."
3. "I will expect my stoma to turn pale and dry as it heals."
4. "I will tell pharmacists that some slow-release tablets may pass whole." **✔ 정답**

**정답: 4**

## 해설

An ileostomy bypasses the colon, and some enteric-coated or extended-release tablets may pass without being absorbed. Clients tell prescribers and pharmacists so another form can be chosen. Lotions under the wafer, leaving a leaking or itching wafer in place, and accepting a pale stoma are all unsafe.

## 심화 해설

Why option 4 is correct

An end ileostomy diverts the entire small-bowel effluent away from the colon, so the normal colonic residence time and colonic absorption surface are lost. Medications formulated as enteric-coated or extended-release / slow-release rely on a specific pH environment, transit time, or intact coating to release the drug gradually. In a patient with an ileostomy, transit is rapid and the colon is absent, so these products may be expelled into the pouch without being fully dissolved or absorbed. The client’s statement that she will tell pharmacists some slow-release tablets may pass whole is the correct and safest understanding: prescribers and pharmacists can then switch to immediate-release, liquid, or other suitable formulations. The WOCN Society guideline emphasizes that postoperative education must address medication considerations related to the altered gastrointestinal tract, because unrecognized malabsorption can lead to therapeutic failure . Structured stoma teaching that includes this kind of self-management knowledge is a core component of discharge preparation and is linked to better readiness for discharge and self-efficacy [1][2].

Why the other options are unsafe

| Option | Statement | Clinical problem |
| --- | --- | --- |
| 1 | “I will rub moisturizing lotion around the stoma before the wafer goes on.” | Lotions, oils, and creams leave a residue that prevents the skin barrier from adhering. This leads to leakage, peristomal skin breakdown, and chemical irritation from effluent. The peristomal skin should be clean and dry before applying the pouching system . |
| 2 | “I will leave each wafer on for 2 weeks, even if it itches under it.” | Itching under the wafer is an early sign of leakage, moisture-associated skin damage, or fungal irritation. Leaving the wafer in place allows effluent to remain in contact with the skin, worsening breakdown. The wafer should be changed when itching, burning, or leakage occurs . |
| 3 | “I will expect my stoma to turn pale and dry as it heals.” | A healthy stoma is pink or red and moist. A pale, dusky, or dry stoma suggests ischemia or necrosis and requires immediate evaluation. The client’s current pink, moist, slightly swollen stoma is the expected early postoperative appearance . |

Watch out! The distractor statements are all variations of common peristomal skin and stoma viability errors. A stoma that changes color to pale or dark, or peristomal skin that itches, burns, or weeps, is never a normal healing pattern.

Key point! Discharge teaching for an ileostomy must include medication absorption changes, because the colon is bypassed and extended-release or enteric-coated drugs may pass intact. The client’s role is to inform every prescriber and pharmacist about the ileostomy so that alternative dosage forms can be selected. Structured, nurse-led stoma education improves readiness for discharge and stoma self-efficacy, which in turn supports better quality of life after surgery [1][2].References (research sources)

- [1]Discharge teaching quality positively predicts quality of life in colorectal cancer patients with temporary enterostomy: The mediating role of readiness for hospital discharge and stoma self-efficacy.Research articleLin L, Fang Y, Huang F, Zhang X, Zheng J, Xiao H (2024) · DOI: 10.1371/journal.pone.0306981

- [2]Teaching stoma-management skills: the importance of self-care.Research articleO'Connor G (2005) · DOI: 10.12968/bjon.2005.14.6.17800

## 임상 시나리오

Ileostomy Medication SafetyPreventing therapeutic failure after colectomy
An ileostomy bypasses the colon, so enteric-coated and extended-release tablets may pass whole into the pouch without being absorbed. Teach patients to tell every prescriber and pharmacist about their ileostomy so formulations can be changed to immediate-release, liquid, or other suitable options.

A healthy stoma is pink and moist. Pale, dusky, or dry stomas suggest ischemia and need immediate evaluation. Do not apply lotions, oils, or creams around the stoma because residue prevents wafer adhesion and leads to leakage and peristomal skin breakdown.

CautionChange the wafer when itching, burning, or leakage occurs. Leaving a leaking wafer in place exposes skin to digestive effluent and causes rapid chemical irritation.

## 핵심 개념

- **Ileostomy** — Surgical opening of the ileum to the abdominal surface, bypassing the colon and reducing absorption time
- **Extended-release tablet** — Formulation designed to dissolve slowly; may pass whole through an ileostomy without being absorbed
- **Peristomal skin** — Skin surrounding the stoma that must remain intact and dry for the pouch wafer to adhere
- **Stoma ischemia** — Inadequate blood flow to the stoma, indicated by pale, dusky, or dry appearance

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