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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Risk for Constipation or Diarrhea

Nursing Diagnosis

Risk factors may include

  • Placement of ostomy in descending or sigmoid colon
  • Inadequate diet/fluid intake

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 establish an elimination pattern suitable to physical needs and lifestyle with the effluent of appropriate amount and consistency.
Nursing InterventionsRationale
Ascertain patient’s previous bowel habits and lifestyle.Assists in the formulation of a timely or effective irrigating schedule for a patient with a colostomy, if appropriate.
Investigate delayed onset or absence of effluent. Auscultate bowel sounds.Postoperative paralytic and/or adynamic ileus usually resolves within 48–72 hr and ileostomy should begin draining within 12–24 hr. Delay may indicate persistent ileus or stomal obstruction, which may occur postoperatively because of edema, improperly fitting pouch (too tight), prolapse, or stenosis of the stoma.
Inform patient with an ileostomy that initially the effluent is liquid. If constipation occurs, it should be reported to enterostomal nurse or physician.Although the small intestine eventually begins to take on water-absorbing functions to permit a more semi-solid, pasty discharge, constipation may indicate an obstruction. Absence of stool requires emergency medical attention.
Review dietary pattern and amount, type of fluid intake.Adequate intake of fiber and roughage provides bulk, and fluid is an important factor in determining the consistency of the stool.
Review physiology of the colon and discuss irrigation management of sigmoid ostomy, if appropriate.This knowledge helps the patient understand individual care needs.
Demonstrate use of irrigation equipment per institution policy or under the guidance of a physician or certified wound, ostomy, continence nurse.Irrigations may be done on a daily basis if appropriate, although there are differing views on this practice. Many believe cleaning the bowel on a regular basis is helpful. Others believe that this interferes with normal functioning.
Instruct patient in the use of closed-end pouch or a patch, dressing or Band-Aid when irrigation is successful and the sigmoid colostomy effluent becomes more manageable, with stool expelled every 24 hr.Enables the patient to feel more comfortable socially and is less expensive than regular ostomy pouches.
Involve patient in the care of the ostomy on an increasing basis.Rehabilitation can be facilitated by encouraging patient independence and control.
Instruct in use of TENS unit if indicated.Electrical stimulation has been used in some patients to stimulate peristalsis and relieve postoperative ileus.
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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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