Question

When changing Mrs. Warren's ileostomy bag, the nurse notices that the peristomal skin is irritated.

Which of these actions by the nurse would be appropriate before reapplying the appliance?
1) Wash the area with antiseptic soap and water.
2) Clean the site with Dakin's solution.
3) Use a solid skin barrier.
4) Obtain an order for a topical antibiotic.

Answer 1

The nurse should use a solid skin barrier to protect the irritated peristomal skin. Gentle cleaning with mild soap and water and ensuring no residue is left before applying a new ileostomy bag is recommended. The use of a topical antibiotic should be considered if the skin is infected.

Step-by-step explanation:

When changing Mrs. Warren's ileostomy bag and noting peristomal skin irritation, before reapplying the appliance, the nurse would take appropriate steps to ensure the skin is treated correctly. Using a solid skin barrier is one recommended action since it can protect the irritated skin from further damage from the stool that is diverted to the ileostomy bag. Antiseptic soap may be too harsh for the irritated skin, and using Dakin's solution (a diluted bleach solution) is typically reserved for infected wounds. Unless the skin is infected, rather than just irritated, obtaining an order for a topical antibiotic might not be necessary. It is crucial to clean the area gently with mild soap and water, pat it dry, and ensure no residue is left that could interfere with the adhesion of the new appliance. The use of skin barriers can help prevent further skin damage and promote healing.