10 Ileostomy and Colostomy Nursing Care Plans


An ileostomy is an opening constructed in the terminal ileum to treat regional and ulcerative colitis and to divert intestinal contents in colon cancer, polyps, and trauma. It is usually done when the entire colon, rectum, and anus must be removed, in which case the ileostomy is permanent. A temporary ileostomy is done to provide complete bowel rest in conditions such as chronic colitis and in some trauma cases.

colostomy is a diversion of the effluent of the colon and may be temporary or permanent. Ascending, transverse, and sigmoid colostomies may be performed. Transverse colostomy is usually temporary. A sigmoid colostomy is the most common permanent stoma, usually performed for cancer treatment.

Nursing Care Plans

Nursing care management and planning for patients with ileostomy or colostomy includes: assisting the patient and/or SO during the adjustment, preventing complications, support independence in self-care, provide information about procedure/prognosis, treatment needs, and potential complications.

Here are 10 nursing care plans (NCP) and nursing diagnosis for patients with fecal diversions: colostomy and ileostomy:

  1. Risk for Impaired Skin Integrity
  2. Disturbed Body Image
  3. Acute Pain
  4. Impaired Skin Integrity
  5. Deficient Fluid Volume
  6. Risk for Imbalanced Nutrition: Less Than Body Requirements
  7. Risk for Sexual Dysfunction
  8. Disturbed Sleep Pattern
  9. Risk for Constipation or Diarrhea
  10. Deficient Knowledge
  11. Other Nursing Care Plans

Risk for Impaired Skin Integrity

Nursing Diagnosis

Risk factors may include

  • Absence of sphincter at the stoma
  • Character/flow of effluent and flatus from the stoma
  • Reaction to product/chemicals; improper fitting/care of appliance/skin

Possibly evidenced by

  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • Client will maintain skin integrity around the stoma.
  • Client will identify individual risk factors.
  • Client will demonstrate behaviors/techniques to promote healing/prevent skin breakdown.
Nursing InterventionsRationale
Inspect stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color), rashesMonitors the healing process and effectiveness of appliances and identifies areas of concern, need for further evaluation and intervention. Early identification of stomal necrosis or ischemia or fungal infection (from changes in normal bowel flora) provides for timely interventions to prevent serious complications. Stoma should be red and moist. Ulcerated areas on stoma may be from a pouch opening that is too small or a faceplate that cuts into stoma. In patients with an ileostomy, the effluent is rich in enzymes, increasing the likelihood of skin irritation. In patient with a colostomy, skin care is not as great a concern because the enzymes are no longer present in the effluent.
Clean with warm water and pat dry. Use soap only if area is covered with sticky stool. If paste has collected on the skin, let it dry, then peel it off.Maintaining a clean and dry area helps prevent skin breakdown.
Measure stoma periodically: at least weekly for first 6 wk, then once a month for 6 mo. Measure both width and length of stoma.As postoperative edema resolves (during first 6 wk), the stoma shrinks and size of appliance must be altered to ensure proper fit so that effluent is collected as it flows from the ostomy and contact with the skin is prevented.
Verify that opening on adhesive backing of the pouch is at least 1⁄16 to 1⁄8 in (2–3 mm) larger than the base of the stoma, with adequate adhesiveness left to apply pouch.Prevents trauma to the stoma tissue and protects the peristomal skin. Adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis.
Use a transparent, odor-proof drainable pouch.A transparent appliance during first 4–6 wk allows easy observation of stoma without necessity of removing pouch/irritating skin.
Apply appropriate skin barrier: hydrocolloid wafer, karaya gun, extended-wear skin barrier, or similar products.Protects skin from pouch adhesive, enhances adhesiveness of pouch, and facilitates removal of pouch when necessary. Note: Sigmoid colostomy may not require use of a skin barrier once stool becomes formed and elimination is regulated through irrigation.
Empty, irrigate, and cleanse ostomy pouch on a routine basis, using appropriate equipment.Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution not only removes bacteria and odor-causing stool and flatus but also deodorizes the pouch.
Support surrounding skin when gently removing appliance. Apply adhesive removers as indicated, then wash thoroughly.Prevents tissue irritation or destruction associated with “pulling” pouch off.
Investigate reports of burning, itching, or blistering around stoma.Indicative of effluent leakage with peristomal irritation, or possibly Candida infection, requiring intervention.
Evaluate adhesive product and appliance fit on ongoing basis.Provides opportunity for problem solving. Determines need for further intervention.
Consult with certified wound, ostomy, continence nurse.Helpful in choosing products appropriate for patient’s particular rehabilitation needs, including type of ostomy, physical/mental status, abilities to handle self-care, and financial resources.
Apply corticosteroid aerosol spray and prescribed antifungal powder as indicated.Assists in healing if peristomal irritation persists and/or fungal infection develops. Note: These products can have potent side effects and should be used sparingly.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:


Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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