The nurse plans care for a client with Crohn's disease who has a heavily draining fistula. Which intervention would be the nurse's priority?

Choice A reason: Fistula drainage from the bowel contains caustic enzymes and gastric acids that cause rapid, severe excoriation and breakdown of the surrounding skin. Maintaining skin integrity is the priority nursing intervention to prevent secondary infections, pain, and complex wound management issues associated with enzymatic skin digestion. Choice B reason: A low-fiber (low-residue) diet is often indicated during exacerbations of Crohn's disease to reduce bowel frequency and irritation. However, it is not the most immediate or critical priority when a patient has an active, heavily draining fistula that poses a direct threat to integumentary health. Choice C reason: Antibiotics are frequently used to treat infections associated with fistulas, such as abscesses. While important for managing the underlying infectious process, the immediate physical threat of skin maceration and tissue destruction from the drainage itself requires more urgent nursing attention and protective barriers. Choice D reason: Intravenous glucocorticoids are used to manage systemic inflammation in Crohn's disease. While they help treat the underlying disease activity, they can also delay wound healing. They do not address the immediate, localized problem of corrosive drainage damaging the patient's external abdominal or perianal tissue.