A nurse is preparing to obtain a 24-hr urine collection from a client.Which of the following actions should the nurse plan to take?

Findings that require follow-up:

1. Refuses to look at the stoma:
   • This indicates the client is experiencing emotional or psychological distress related to the ileostomy. It may hinder his ability to learn and participate in self-care, which is crucial for managing the ileostomy effectively.
2. Expresses no interest in learning about stoma care:
   • Lack of interest in learning about stoma care suggests the client is not prepared or willing to take responsibility for his own care, which can lead to complications and poor outcomes. Education and support are needed to help the client become more comfortable and knowledgeable about managing the ileostomy.
3. The skin surrounding the stoma is reddened and has small open areas:
   • This indicates irritation or infection of the skin around the stoma, which requires prompt attention to prevent further complications and ensure proper healing. It may be necessary to review the client's stoma care routine and make adjustments to prevent skin breakdown.
4. During cleaning, a small amount of bleeding was noted from the stoma:
   • Bleeding from the stoma can be a sign of trauma, infection, or other issues that need to be addressed. Prompt evaluation and intervention are necessary to identify the cause and prevent further complications.

Findings that do not require follow-up:

1. The client's abdomen is soft and nondistended:
   • This is a normal finding, indicating that there is no abdominal distention or rigidity, which could be signs of underlying issues such as bowel obstruction or peritonitis.
2. The stoma is red and is draining brown liquid stool:
   • A red stoma with brown liquid stool is generally a normal finding, as the stoma should be red or pink in color and the stool consistency can vary based on the type of ileostomy and the client's diet.
3. The client appears alert and oriented to person, place, and time:
   • This indicates the client is mentally alert and aware of his surroundings, which is a positive sign of overall cognitive function and well-being.
4. The ileostomy pouch was changed:
   • Changing the ileostomy pouch is a routine part of stoma care and does not indicate any issues that require follow-up unless there are problems noted during the process, such as skin irritation or pouch leakage.

Choice A rationale

Neobladder urinary diversion involves creating an internal reservoir or pouch from a segment of the intestine to store urine. This new bladder is then connected to the urethra, enabling the client to void through the urethra. This method closely mimics natural urination, allowing the client to have some control over urination.

Choice B rationale

This is incorrect because a neobladder is designed to allow the client to control urination. While there might be a learning curve for the client to adapt to the new bladder, the ultimate goal is to achieve continence.

Choice C rationale

This describes an ileal conduit, another type of urinary diversion, where a stoma is created on the abdomen for urine to pass into an external bag. The neobladder does not involve a stoma for urination.

Choice D rationale

This is incorrect as it pertains to an ileal conduit or urostomy. Clients with a neobladder do not require an external collection bag since urine is stored internally in the constructed bladder and can be passed through the urethra. .