# Situation: A 58-year-old man had a sigmoid resection with an end colostomy in the left lower quadrant (Hartmann procedure) for perforated diverticulitis. Before discharge, he asks when to empty the pouch. What should the nurse advise?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630488  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 58-year-old man had a sigmoid resection with an end colostomy in the left lower quadrant (Hartmann procedure) for perforated diverticulitis.

Before discharge, he asks when to empty the pouch. What should the nurse advise?

## 보기

1. Every 2 hours, whether or not it has contents
2. When it is one-third to one-half full **✔ 정답**
3. At each change of the skin barrier
4. When it is completely full and heavy

**정답: 2**

## 해설

The pouch is emptied when it is one-third to one-half full to prevent its weight from pulling the barrier away from the skin and causing leakage.

## 심화 해설

Empty at one-third to one-half full
The colostomy pouch is emptied when it is one-third to one-half full. Emptying at this level keeps the weight of stool and gas from pulling the skin barrier away from the skin. A heavy pouch drags on the adhesive seal, breaks it, and allows stool to leak onto the peristomal skin, causing irritation and skin breakdown. Emptying early also reduces bulging under clothing, odor when the pouch is opened, and the embarrassment that discourages clients from going out.

Emptying versus changing
Clients often confuse emptying the pouch with changing the appliance. Emptying, through the drainable outlet, happens several times a day depending on output. Changing the skin barrier (wafer) and pouch happens much less often, typically every 3–7 days, or sooner if it leaks or the skin under it itches or burns. Teaching both separately prevents a client from waiting for a barrier change to empty a full pouch.

| Teaching point | Correct practice |
| --- | --- |
| When to empty | At one-third to one-half full |
| When to change the barrier | Every 3–7 days, or if leaking or itching |
| Fixed time schedule | Not used; depends on how full the pouch is |
| Waiting until full | Avoided; weight breaks the seal and causes leaks |

Why the other options are wrong
Emptying every 2 hours regardless of contents is unnecessary and ignores how much output there actually is. Emptying only at each barrier change means the pouch would become heavy and leak between changes. Waiting until the pouch is completely full and heavy is the exact situation the teaching aims to prevent. Watch out! Answers that set a fixed clock time sound organized, but stoma output varies, and the pouch is emptied by fullness.

Exam takeaway
Discharge teaching for a new colostomy covers emptying, barrier changes, skin care, diet, odor control, and when to call for help, such as a change in stoma color, persistent leakage, or skin breakdown. Key point! Empty the pouch when it is one-third to one-half full; change the barrier every 3 to 7 days.

## 임상 시나리오

Colostomy Pouch CareWhen to empty the pouch
Empty the drainable pouch when it is one-third to one-half full to prevent its weight from pulling the barrier off the skin.

Change the skin barrier every 3–7 days, or sooner if it leaks or the skin underneath itches or burns.

Emptying depends on fullness, not on a fixed time schedule.

CautionA full, heavy pouch breaks the seal, leaks stool onto the skin, and causes peristomal skin damage.

## 핵심 개념

- **Drainable pouch** — An ostomy bag with an opening at the bottom that can be emptied without removing the appliance.
- **Skin barrier** — The adhesive wafer around the stoma that protects the skin and holds the pouch in place.
- **Peristomal skin** — The skin immediately surrounding a stoma, at risk of irritation from stool leakage.
- **Colostomy** — A surgical opening of the colon onto the abdominal wall through which stool leaves the body.

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