Constipation/Diarrhea — Ileostomy & Colostomy Nursing Care Plan (NCP)

NURSING DIAGNOSIS: Constipation/Diarrhea, risk for

Risk factors may include

• Placement of ostomy in descending or sigmoid colon
• Inadequate diet/fluid intake

Possibly evidenced by

• [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

Bowel Elimination (NOC)

• Establish an elimination pattern suitable to physical needs and lifestyle with effluent of appropriate amount and consistency.

Constipation/Diarrhea — Ileostomy & Colostomy Nursing Care Plan (NCP)

Nursing Interventions	Rationale
Ascertain patient’s previous bowel habits and lifestyle.	Assists in formulation of a timely/effective irrigating schedule for patient with a colostomy, if appropriate.
Investigate delayed onset/absence of effluent. Auscultate bowel sounds.	Postoperative paralytic/adynamic ileus usually resolves within 48–72 hr, and ileostomy should begin draining within 12–24 hr. Delay may indicate persistent ileus or stomal obstruction, which may occur postoperatively because of edema, improperly fitting pouch (too tight), prolapse, or stenosis of the stoma.
Inform patient with an ileostomy that initially the effluent is liquid. If constipation occurs, it should be reported to enterostomal nurse or physician.	Although the small intestine eventually begins to take on water-absorbing functions to permit a more semisolid, pasty discharge, constipation may indicate an obstruction.Absence of stool requires emergency medical attention.
Review dietary pattern and amount/type of fluid intake.	Adequate intake of fiber and roughage provides bulk, and fluid is an important factor in determining the consistency of the stool.
Review physiology of the colon and discuss irrigation management of sigmoid ostomy, if appropriate.	This knowledge helps patient understand individual care needs.
Demonstrate use of irrigation equipment per institution policy or under guidance of physician or certified wound, ostomy, continence nurse.	Irrigations may be done on a daily basis if appropriate, although there are differing views on this practice. Many believe cleaning the bowel on a regular basis is helpful. Others believe that this interferes with normal functioning. (Most authorities agree that occasional irrigation is useful for emptying the bowel to avoid leakage when special events are planned.)
Instruct patient in the use of closed-end pouch or a patch, dressing/Band-Aid when irrigation is successful and the sigmoid colostomy effluent becomes more manageable, with stool expelled every 24 hr.	Enables patient to feel more comfortable socially and is less expensive than regular ostomy pouches.
Involve patient in care of the ostomy on an increasing basis.	Rehabilitation can be facilitated by encouraging patient independence and control.
Instruct in use of TENS unit if indicated.	Electrical stimulation has been used in some patients to stimulate peristalsis and relieve postoperative ileus.

Found through:

acute pain ncp for diarrhea, nursing mnemonics