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. A 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 include: assisting the patient and/or SO during the adjustment, preventing complications, supporting independence in self-care, provide information about procedure/prognosis, treatment needs, and potential complications.

Here are 10 nursing care plans (NCP) and nursing diagnoses 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

  • The client will maintain skin integrity around the stoma.
  • The client will identify individual risk factors.
  • The client will demonstrate behaviors/techniques to promote healing/prevent skin breakdown.

Nursing Assessment and Rationales

1. Inspect the stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color), rashes
Monitors 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 the stoma may be from a pouch opening that is too small or a faceplate that cuts into the stoma. In patients with an ileostomy, the effluent is rich in enzymes, increasing the likelihood of skin irritation. In patients with a colostomy, skin care is not as great a concern because the enzymes are no longer present in the effluent.

2. Measure stoma periodically: at least weekly for the first 6 wk, then once a month for 6 mo. Measure both the width and length of the stoma.
As postoperative edema resolves (during the first 6 wk), the stoma shrinks and the size of the 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.

3. Investigate reports of burning, itching, or blistering around the stoma.
Indicative of effluent leakage with peristomal irritation, or possibly Candida infection, requiring intervention.

Nursing Interventions and Rationales

1. Clean with warm water and pat dry. Use soap only if the area is covered with a sticky stool. If the paste has collected on the skin, let it dry, then peel it off.
Maintaining a clean and dry area helps prevent skin breakdown.

2. Verify that the opening on the 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 the pouch.
Prevents trauma to the stoma tissue and protects the peristomal skin. An adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis.

3. Use a transparent, odor-proof drainable pouch.
A transparent appliance during the first 4–6 wk allows easy observation of the stoma without the necessity of removing the pouch/irritating skin.

4. 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 the pouch when necessary. Note: Sigmoid colostomy may not require the use of a skin barrier once stool becomes formed and elimination is regulated through irrigation.

5. Empty, irrigate, and cleanse the 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.

6. Support surrounding skin when gently removing the appliance. Apply adhesive removers as indicated, then wash thoroughly.
Prevents tissue irritation or destruction associated with “pulling” the pouch off.

7. Evaluate adhesive product and appliance fit on an ongoing basis.
Provides an opportunity for problem-solving. Determines the need for further intervention.

8. Consult with a certified wound, ostomy, and continence nurse.
Helpful in choosing products appropriate for the patient’s particular rehabilitation needs, including the type of ostomy, physical/mental status, abilities to handle self-care, and financial resources.

9. 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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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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