A nurse is completing discharge teaching about ostomy care with a client who has a new stoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Rationale A. "Empty the ostomy pouch when it becomes one-third full of contents.": Emptying the pouch before it becomes too full prevents leakage, skin irritation, and discomfort. Regular emptying supports hygiene and maintains appliance adherence, which is essential for stoma care. B. "Expect the stoma to turn a purple-blue color as it heals.": A healthy stoma should be pink to red, indicating good perfusion. Purple-blue discoloration may indicate ischemia or compromised blood flow, which requires immediate provider notification. C. "Place a piece of gauze over the stoma while changing the pouch.": Gauze is not necessary and may interfere with proper pouch application. Direct handling with clean technique and using the appliance as designed is sufficient for maintaining hygiene and protecting the stoma. D. "Cut the opening of the pouch 1/8 of an inch larger than the stoma.": Ensuring the pouch opening is slightly larger than the stoma protects peristomal skin from contact with effluent while maintaining a secure fit. Accurate sizing is critical for preventing skin breakdown and leakage. E. "Use povidone-iodine to clean around the stoma.": Povidone-iodine is harsh and can irritate peristomal skin. Gentle washing with warm water and mild soap is recommended to preserve skin integrity and prevent irritation.