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. Fold the existing patch on itself and dispose of it in a childproof container: Folding the patch so the adhesive sides stick together prevents accidental exposure to medication, which could harm others. Proper disposal in a secure container ensures safety and prevents accidental ingestion or contact, especially for potent medications like opioids or nitroglycerin.

B. Shave the client's lower leg for placement of the new patch: Shaving is unnecessary unless hair significantly interferes with adhesion. Using razors can cause microabrasions, increasing the risk of skin irritation or infection. Hair can usually be trimmed with scissors instead of shaving.

C. Discard the old patch and apply a new one in the same location: Applying a new patch to the same site can cause skin irritation or burns due to repeated exposure. Rotation of application sites is necessary to allow the skin to recover and to maintain patch efficacy.

D. Keep the existing patch on and place the new patch in a different location: Leaving the old patch in place results in double dosing, which can lead to toxicity. All transdermal patches should be removed before applying a new one to prevent accidental overdose.

Rationale

A. Respiratory therapist: Respiratory therapists focus on airway management, pulmonary function, and respiratory interventions. Assistance with dressing is not within their scope of practice and does not relate to pulmonary or ventilatory needs. Reporting dressing difficulties to them would not contribute to the client’s functional recovery.

B. Physical therapist: Physical therapists focus on mobility, strength, range of motion, and gait training. While they may help with lower extremity function, they do not specialize in teaching or assisting with self-care activities like dressing, which is a focus of occupational therapy.

C. Social worker: Social workers address psychosocial needs, discharge planning, and community resources. They are not directly involved in the client’s ability to perform activities of daily living such as dressing, so reporting this information to them would not address the immediate functional concern.

D. Occupational therapist: Occupational therapists specialize in activities of daily living, including dressing, grooming, and self-care. They can assess the client’s functional limitations, recommend adaptive equipment, and provide strategies to enhance independence in dressing following surgery. This ensures the client receives appropriate rehabilitation support.