10 Ileostomy and Colostomy Nursing Care Plans

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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:

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  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
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Disturbed Body Image

Nursing Diagnosis

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

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  • 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

  • Client will verbalize acceptance of self in situation, incorporating change into self-concept without negating self-esteem.
  • Client will demonstrate beginning acceptance by viewing/touching stoma and participating in self-care.
  • Client will verbalize feelings about stoma/illness; begin to deal constructively with situation.
Nursing InterventionsRationale
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 an individual situation.
Encourage patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over a loss. Discuss daily “ups and downs” that can occur.Helps the patient realize that feelings are not unusual and that feeling guilty about them is not necessary or helpful. Patient needs to recognize feelings before they can be dealt with effectively.
Review the reason for surgery and future expectations.Patient may find it easier to accept or deal with an ostomy done to correct chronic or 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 non-involvement 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 the 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 the 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 an opportunity for the patient to deal with ostomy through participation in self-care.Independence in self-care helps improve self-confidence and acceptance of the situation.
Plan/schedule care activities with the patient.Promotes a sense of control and gives a message that patient can handle the situation, enhancing self-concept.
Maintain a positive approach during care activities, avoiding expressions of disdain or revulsion. Do not take angry expressions of the patient and SO personally.Assists patient and 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 a 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 the patient realizes “life does go on” and can be relatively normal.
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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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