A nurse is reinforcing teaching with another nurse about how to change an ostomy appliance for a client who has a sigmoid colostomy. Which of the following instructions should the nurse include in the teaching?

A. Use a moisturizing soap to clean the skin around the client's stoma. Using moisturizing soap is not recommended because it can leave a residue that interferes with the adhesion of the skin barrier. A mild, non-moisturizing soap should be used to cleanse the area, followed by thorough rinsing and drying. B. Change the client's ostomy appliance 1 hr after breakfast. Changing the ostomy appliance should ideally be done when the stoma is less active, which is usually before meals or several hours after meals. Changing it right after breakfast may lead to difficulty managing output if the stoma is still active. C. Create an opening on the skin barrier that is 1.27 cm (0.5 in) larger than the client's stoma. The skin barrier opening should be cut to fit the stoma snugly, typically 1/8 inch (0.3 cm) larger than the stoma size, not 0.5 inches. A larger opening can lead to skin irritation and leakage. D. Empty the client's ostomy pouch before removing the skin barrier. This is an important step to minimize the risk of spills and make the process more manageable. Emptying the pouch ensures that the contents do not leak out during the change, helping maintain a clean and safe environment during the procedure.