A.T. eventually masters the pouch application and is discharged to home. She returns to the urology
clinic in 1 month for a follow-up visit.
She has lost 8 pounds and is seen with a smaller stoma which is surrounded by a crusty material and reddened skin. A.T. asks you if it is normal for the stoma to shrink, and
what can be done about the crusty material around the stoma.
How will you answer A.T.'s questions?
It is normal for the stoma to shrink somewhat during the first few weeks, up to a year, after the
surgery. The encrustations and reddened skin are caused by alkaline urine washing over the skin
around the stoma. The alkaline urine caused ammonia salts to deposit around the stoma. Keeping
the urine acidic can help to prevent alkaline encrustations. She will need meticulous skin care to
remove the crusty material and treat the dermatitis. Ensure that the pouch is fitted properly. You can
also call the CWOCN for a consultation as needed.
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