Disturbed Body Image — Ileostomy & Colostomy Nursing Care Plan (NCP)

NURSING DIAGNOSIS: Body Image, disturbed

May be related to

• Biophysical: presence of stoma; loss of control of bowel elimination
• Psychosocial: altered body structure
• Disease process and associated treatment regimen, e.g., cancer, colitis

Possibly evidenced by

• Verbalization of change in body image, fear of rejection/reaction of others, and negative feelings about body
• Actual change in structure and/or function (ostomy)
• Not touching/looking at stoma, refusal to participate in care

Desired Outcomes

Body Image (NOC)

• Verbalize acceptance of self in situation, incorporating change into self-concept without negating self-esteem.
• Demonstrate beginning acceptance by viewing/touching stoma and participating in self-care.
• Verbalize feelings about stoma/illness; begin to deal constructively with situation.

Disturbed Body Image — Ileostomy & Colostomy Nursing Care Plan (NCP)

Nursing Interventions	Rationale
Ascertain whether support and counseling were initiated when the possibility and/or necessity of ostomy was first discussed.	Provides information about patient’s/SO’s level of knowledge and anxiety about individual situation.
Encourage patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over loss. Discuss daily “ups and downs” that can occur.	Helps patient realize that feelings are not unusual and that feeling guilty about them is not necessary/helpful. Patient needs to recognize feelings before they can be dealt with effectively.
Review reason for surgery and future expectations.	Patient may find it easier to accept/deal with an ostomy done to correct chronic/long-term disease than for traumatic injury, even if ostomy is only temporary. Also, patient who will be undergoing a second procedure (to convert ostomy to a continent or anal reservoir) may possibly encounter less severe self-image problems because body function eventually will be “more normal.”
Note behaviors of withdrawal, increased dependency, manipulation, or noninvolvement in care.	Suggestive of problems in adjustment that may require further evaluation and more extensive therapy.
Provide opportunities for patient/SO to view and touch stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind patient that it will take time to adjust, both physically and emotionally.	Although integration of stoma into body image can take months or even years, looking at the stoma and hearing comments (made in a normal, matter-of-fact manner) can help patient with this acceptance. Touching stoma reassures patient/SO that it is not fragile and that slight movements of stoma actually reflect normal peristalsis.
Provide opportunity for patient to deal with ostomy through participation in self-care.	Independence in self-care helps improve self-confidence and acceptance of situation.
Plan/schedule care activities with patient.	Promotes sense of control and gives message that patient can handle situation, enhancing self-concept.
Maintain positive approach during care activities, avoiding expressions of disdain or revulsion. Do not take angry expressions of patient/SO personally.	Assists patient/SO to accept body changes and feel all right about self. Anger is most often directed at the situation and lack of control individual has over what has happened (powerlessness), not with the individual caregiver.
Ascertain patient’s desire to visit with a person with an ostomy. Make arrangements for visit, if desired.	A person who is living with an ostomy can be a good support system/role model. Helps reinforce teaching (shared experiences) and facilitates acceptance of change as patient realizes “life does go on” and can be relatively normal.

Found through:

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