A nurse is caring for a patient with an ileostomy. Which action by the nurse is most appropriate?

Choice A reason: Using soap and water to cleanse the stoma site risks skin irritation, as soap can disrupt the skin’s natural barrier, leading to dermatitis or poor pouch adhesion. Gentle cleansing with water or specialized products is preferred to maintain peristomal skin integrity and prevent complications. Choice B reason: Leaving a 1/2-inch space around the stoma is excessive. The barrier should fit closely (1/16 to 1/8 inch) to protect peristomal skin from effluent, which can cause irritation or breakdown. A larger gap risks skin damage, compromising pouch adherence and patient comfort. Choice C reason: Emptying the pouch when one-third to one-half full is appropriate. This prevents leakage, reduces pouch weight, and maintains skin integrity by minimizing effluent contact. Regular emptying supports patient comfort and prevents complications like skin irritation or pouch detachment, critical for ileostomy care. Choice D reason: Changing the skin barrier daily is unnecessary unless leakage or skin issues occur. Barriers typically last 3-7 days, depending on output and skin condition. Daily changes risk skin trauma from frequent adhesive removal, increasing irritation and compromising peristomal skin health.