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.
A 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.
- Risk for Impaired Skin Integrity
- Disturbed Body Image
- Acute Pain
- Impaired Skin Integrity
- Deficient Fluid Volume
- Risk for Imbalanced Nutrition: Less Than Body Requirements
- Risk for Sexual Dysfunction
- Disturbed Sleep Pattern
- Risk for Constipation or Diarrhea
- Deficient Knowledge
- Other Nursing Care Plans
May be related to
- Lack of exposure/recall information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; statement of misconception/misinformation
- Inaccurate follow-through of instruction/performance of ostomy care
- Inappropriate or exaggerated behaviors (e.g., hostile, agitated, apathetic, withdrawal)
- Client will verbalize understanding of condition/disease process, prognosis, and potential complications.
- Client will verbalize understanding of therapeutic needs.
- Client will correctly perform necessary procedures, explain reasons for the action.
- IClient will initiate necessary lifestyle changes.
|Evaluate the patient’s emotional, cognitive, and physical capabilities.||These factors affect the patient’s ability to master care-tasks and willingness to assume responsibility for ostomy care.|
|Include written, picture (photo, video, Internet) learning resources.||Provides references for obtaining support, equipment, and additional information after discharge to support patient efforts for independence in self-care.|
|Review anatomy, physiology, and implications of surgical intervention. Discuss future expectations, including anticipated changes in the character of effluent.||Provides knowledge base from which patient can make informed choices, and offers an opportunity to clarify misconceptions regarding an individual situation.|
|Instruct patient/SO in stomal care. Allot time for return demonstrations and provide positive feedback for efforts.||Promotes positive management and reduces the risk of improper ostomy care and development of complications.|
|Recommend increased fluid intake during warm weather months.||Loss of normal colon function of conserving water and electrolytes can lead to dehydration and constipation.|
|Discuss the possible need to decrease salt intake.||Salt can increase ileal output, potentiating the risk of dehydration and increasing frequency of ostomy care needs and/or patient’s inconvenience.|
|Identify symptoms of electrolyte depletion: anorexia, abdominal muscle cramps, feelings of faintness or “cold” in arms, legs, general fatigue, weakness, bloating, decreased sensations in arms or legs.||Loss of colon function altering fluid and electrolyte absorption may result in sodium or potassium deficits requiring dietary correction with foods and fluids high in sodium (bouillon, Gatorade) or potassium (orange juice, prunes, tomatoes, bananas, Gatorade).|
|Discuss the need for periodic evaluation and administration of supplemental vitamins and minerals as appropriate.||Depending on portion and amount of bowel resected, lack of absorption may cause deficiencies.|
|Stress importance of chewing food well, adequate intake of fluids with or following meals, only moderate use of high-fiber foods, avoidance of cellulose.||Reduces the risk of bowel obstruction, especially in a patient with ileostomy.|
|Review foods that may be a source of flatus. For example: carbonated drinks, beans, beer, cabbages, onions, fish and highly seasoned food.||These foods may be restricted or eliminated, based on individual reaction, for better ostomy control, or it may be necessary to empty the pouch more frequently if they are ingested.|
|Identify foods associated with diarrhea, such as green beans, broccoli, highly seasoned foods.||Promotes more even effluent and better control of evacuations.|
|Recommend foods used to manage constipation (bran, celery, raw fruits), and discuss the importance of increased fluid intake.||Proper management can prevent or minimize problems of constipation.|
|Discuss the resumption of the presurgery level of activity. Suggest emptying the ostomy appliance before leaving home and carrying a fanny pack with fresh supplies. Recommend resources for obtaining attractive appliances and decorative cummerbunds as appropriate.||With a little planning, patient should be able to manage the same degree of activity as previously enjoyed and in some cases increase activity level. A cummerbund can provide both physical and psychological support when the patient is involved in activities such as tennis and swimming.|
|Talk about the possibility of sleep disturbance, anorexia, loss of interest in usual activities.||“Homecoming depression” may occur, lasting for months after surgery, requiring patience and support and ongoing evaluation as the patient adjusts to living with a stoma.|
|Explain the necessity of notifying healthcare providers and pharmacists of type of ostomy and avoidance of sustained-release medications.||Presence of ostomy may alter the rate and extent of absorption of oral medications and increase the risk of drug-related complications, e.g., diarrhea or constipation or peristomal excoriation. Liquid, chewable, or injectable forms of medication are preferred for patients with an ileostomy to maximize absorption of the drug.|
|Counsel patient concerning medication use and problems associated with altered bowel function. Refer to pharmacist for teaching and/or advice as appropriate.||Patient with an ostomy has two key problems: altered disintegration and absorption of oral drugs and unusual or pronounced adverse effects. Some of the medications that these patients may respond to differently include laxatives, salicylates, H2receptor antagonists, antibiotics, and diuretics.|
|Discuss the effect of medications on effluent, i.e., changes in color, odor, consistency of stool, and need to observe for drug residue indicating incomplete absorption||Understanding decreases anxiety regarding intestinal function and enhances independence in self-care.|
|Stress necessity of close monitoring of chronic health conditions requiring routine oral medications.||Monitoring of clinical symptoms and serum blood levels is indicated because of altered drug absorption requiring periodic dosage adjustments.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More nursing care plans related to gastrointestinal disorders:
- Appendectomy | 4 Care Plans
- Cholecystectomy | 12 Care Plans
- Cholecystitis and Cholelithiasis | 4 Care Plans
- Gastroenteritis | 4 Care Plans
- Hemorrhoids | 3 Care Plans
- Hepatitis | 7 Care Plans
- Ileostomy & Colostomy | 10 Care Plans
- Inflammatory Bowel Disease | 7 Care Plans
- Intussusception | 3 Care Plans
- Liver Cirrhosis | 8 Care Plans
- Pancreatitis | 8+ Care Plans
- Peritonitis | 6 Care Plans
- Peptic Ulcer Disease | 5 Care Plans
- Subtotal Gastrectomy | 2 Care Plans