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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.
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.
Here are 10 nursing care plans (NCP) and nursing diagnosis for patients with fecal diversions: colostomy and ileostomy:
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- 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
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Risk for Sexual Dysfunction
Nursing Diagnosis
- Risk for Sexual Dysfunction
Risk factors may include
- Altered body structure/function; radical resection/treatment procedures
- Vulnerability/psychological concern about response of SO
- Disruption of sexual response pattern, e.g., erectile difficulty
Possibly evidenced by
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- 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 verbalize understanding of relationship of physical condition to sexual problems.
- Client will identify satisfying/acceptable sexual practices and explore alternative methods.
- Client will resume sexual relationship as appropriate.
| Nursing Interventions | Rationale |
|---|---|
| Determine patient’s/SO’s sexual relationship before the disease and/or surgery and whether they anticipate problems related to the presence of ostomy. | Identifies future expectations and desires. Mutilation and loss of privacy and/or control of a bodily function can affect the patient’s view of personal sexuality. When coupled with the fear of rejection by SO, the desired level of intimacy can be greatly impaired. Sexual needs are very basic, and the patient will be rehabilitated more successfully when a satisfying sexual relationship is continued and/or developed as desired. |
| Review with the patient and/or SO sexual functioning in relation to own situation. | Understanding if nerve damage has altered normal sexual functioning helps patient/SO to understand the need for exploring alternative methods of satisfaction. |
| Reinforce the information given by the physician. Encourage questions. Provide additional information as needed. | Reiteration of data previously given assists patient/SO to hear and process the knowledge again, moving toward acceptance of individual limitations or restrictions and prognosis (that it may take up to 2 yr to regain potency after a radical procedure or that a penile prosthesis may be necessary). |
| Discuss the likelihood of a resumption of sexual activity in approximately 6 wk after discharge, beginning slowly and progressing (cuddling, caressing until both partners are comfortable with body image and/or function changes). Include alternative methods of stimulation as appropriate. | Knowing what to expect in progress of recovery helps the patient avoid performance anxiety and/or reduce the risk of “failure.” If the couple is willing to try new ideas, this can assist with adjustment and may help to achieve sexual fulfillment. |
| Encourage dialogue between partners. Suggest wearing pouch cover, T-shirt, shortie nightgown, or underwear sexual activity. | Disguising ostomy appliance may aid in reducing feelings of self-consciousness, embarrassment during specifically designed for sexual contact. |
| Stress awareness of factors that might be distracting (unpleasant odors and pouch leakage). Encourage use of a sense of humor. | Promotes resolution of solvable problems. Laughter can help individuals deal more effectively with a difficult situation, promote positive sexual experience. |
| Problem-solve alternative positions for coitus. | Minimizing the awkwardness of appliance and physical discomfort can enhance satisfaction. |
| Discuss or role play possible interactions or approaches when dealing with new sexual partners. | Rehearsal is helpful in dealing with actual situations when they arise, preventing self-consciousness about “different” body image. |
| Provide birth control information as appropriate and stress that impotence does not necessarily mean the patient is sterile. | Confusion may exist that can lead to an unwanted pregnancy. |
| Arrange a meeting with an ostomy visitor if appropriate. | Sharing of how these problems have been resolved by others can be helpful and reduce a sense of isolation. |
| Refer to sex counseling or therapy if appropriate. | If problems persist longer than several months after surgery, a trained therapist may be required to facilitate communication between patient and SO. |
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Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- 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.
See also
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
Thank you for these nursing care plans! They’re great!
Readiness for enhanced learning (if they are willing to learn)
Thank you for this informative site!
Thank you for the Nursing process its very helpful.
This information is very helpful for us,,thank you so much for helping us
Thanks for these wonderful care plans.