A nurse in a long-term care facility is caring for a client who had abdominal surgery 6 weeks ago.
Which of the following images indicates the client's wound is healing by primary intention?

Choice A rationale: The opening in the skin barrier should be cut approximately 1/16 to 1/8 inch larger than the stoma. A 1/4 inch gap is too large and would expose too much peristomal skin to effluent, significantly increasing the risk of skin irritation and breakdown from digestive enzymes.

Choice B rationale: Emptying the ostomy pouch when it is 1/3 to 1/2 full prevents the weight of the contents from pulling the wafer away from the skin. A pouch that is too full is more likely to leak or detach, causing skin damage and embarrassment for the client.

Choice C rationale: The skin surrounding the stoma should be cleansed with warm water and, if necessary, a mild, non-moisturizing soap. Moisturizing soaps often contain oils or creams that leave a residue on the skin, which prevents the skin barrier from adhering properly.

Choice D rationale: While some colostomies can be irrigated, a standard enema set must never be used. Specialized ostomy irrigation sets are required because they include a cone-tipped irrigator designed to prevent bowel perforation and ensure the fluid enters the stoma safely.

Choice A rationale

Camin is not administered via the Z-track method. This technique is primarily used for certain intramuscular injections that may cause irritation or discoloration if they leak into subcutaneous tissues, which is unrelated to Camin's administration.

Choice B rationale

Folic acid is a water-soluble vitamin typically given orally or intravenously. It does not require the Z-track method, as it does not irritate or stain tissues when administered by other intramuscular techniques.

Choice C rationale

Epoetin alfa is usually administered subcutaneously or intravenously. It does not require the Z-track method, as it is not associated with the risks of tissue irritation or permanent staining.

Choice D rationale

Iron dextran is administered using the Z-track method to prevent irritation, pain, and permanent staining of subcutaneous tissues. The method creates a Z-shaped track in the tissue, sealing off the medication and minimizing leakage.