The enterostomal nurse is conducting a teaching session for patients with new colostomies.Today's topic is self-assessment and signs and symptoms that must be immediately reported to the surgeon.Which sign/symptom should the nurse include in this teaching?

A) Constipation
B) Skin breakdown
C) A stoma that is deep pink to red in color
D) A stoma that is pale, dusky, or black in color

A healthy stoma ranges in color from deep pink to brick red,regardless of the patient's skin color,and is shiny and moist.Pallor or a dusky blue color indicates ischemia,and a brown-black color indicates necrosis.Immediately report to the surgeon a stoma that is pale,dusky,or black in color.These indicate inadequate blood supply to the portion of the intestine that has been externalized.The patient should also pay close attention to the skin surrounding the stoma.Skin breakdown may lead to infection,pain,and leakage.The nurse will provide and further recommend the use of a barrier cream and other skin products.Skin breakdown and constipation may need to be reported to the surgeon depending on the extent of the breakdown and severity of the constipation.However,a change in stoma appearance is critical and warrants immediate attention.