Ileostomy and Colostomy and 5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy.

Ileostomy and Colostomy and 5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy.

This study guide is about ileostomy and colostomy and 5 nursing diagnoses & care plans for ileostomy and colostomy. Use it to create educational nursing care plans for ileostomy and colostomy.

Ileostomy and Colostomy

What is an Ileostomy?

Ileostomy and Colostomy and 5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy.
Ileostomy and Colostomy

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.

What is a colostomy?

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.

Why would you need a colostomy?

You may need a colostomy if you have a medical condition that requires you to stop using your colon or anus normally. It may be a temporary intervention that allows your body to heal, or it may be a permanent solution for an irreversible condition.

Some conditions that may require a temporary colostomy include:

  • Serious infection, such as diverticulitis.
  • Acute inflammation from inflammatory bowel disease (IBD).
  • Acute injury to your colon.
  • An obstruction (or blockage) in your colon or anus.
  • Anal fistula (a tunnel leading from your anal cavity through to your skin or another organ).
  • Partial colectomies (when the remaining ends of the bowels can be reattached later).

Some conditions that may require a permanent colostomy include:

  • Incurable fecal incontinence.
  • Advanced colorectal cancer.
  • Permanent removal of the rectum and/or anus.

What’s the difference between a colostomy and an ileostomy?

Ileostomy and Colostomy and 5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy.
difference between a colostomy and an ileostomy

The colon and the ileum are two different parts of the bowels, also called the intestines. The colon is part of the large intestine, and the ileum is part of the small intestine. In your body, food waste normally passes from your ileum into your colon, where it forms into solid stool. But if the first part of your colon that the ileum feeds into is removed or inactive, this pathway is interrupted.

In this case, an ileostomy redirects your ileum to a stoma in your abdominal wall. When you have an ileostomy, you expel liquid waste from your small intestine through your stoma into an ostomy bag. Like a colostomy, an ileostomy may be either temporary or permanent, depending on your condition. Sometimes, when the colon is permanently unusable, surgeons can create an internal “ileal pouch” to replace it, and close the stoma.

How common is ostomy surgery?

About 100,000 people in the U.S. each year undergo ostomy surgery. About 1 in 500 Americans — up to 1 million people — live with an ostomy. Some call themselves “ostomates.” Because it’s so common, there are a variety of specialized products on the market today to help ostomates live normally and discreetly with their ostomies, including different kinds of ostomy bags, underwear, and swimwear. You can also find ostomy support groups in most areas.

What are the risks of the surgery?

Colostomy is a common and straightforward surgery. It’s generally safe, but there are always some risks. These include:

  • Reactions to the anesthesia.
  • Breathing problems under anesthesia.
  • Injury to nearby organs.
  • Infection.

What complications might occur while living with a colostomy or an ileostomy?

Even when the surgery is successful, you might run into some complications with your colostomy down the road. These include:

  • Skin irritation from contact with stool, especially the acidic, liquid stool of the upper colon. This is the most common stoma complication. It can usually be solved with a better-fitting bag.
  • Bowel obstructions from scar tissue or from paralytic ileus (slow-moving bowels) after your surgery, preventing poop from passing. This can usually be solved with home constipation remedies.
  • Stoma retraction or prolapse. A retracted stoma sinks back below the skin surface level. A prolapsed stoma sticks out too far. Both of these situations can make it difficult to fit your colostomy bag securely to your stoma. If you can’t find a bag that fits, your surgeon may have to re-site or revise your stoma.
  • Parastomal hernia. This type of hernia occurs when loops of bowel bulge through the weakened abdominal muscles around your stoma. A hernia forms a visible bulge next to the stoma and can grow over time, potentially blocking your stoma’s output. Your colostomy nurse will talk to you about preventative measures you can take to prevent a hernia from developing after the surgery.

5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy

What are some of the available nursing diagnoses and care plans for ileostomy and colostomy?

Ileostomy and Colostomy and 5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy.
5 Nursing Diagnoses & Care Plans for Ileostomy and Colostomy: Care Bag

Nursing care management and planning for patients with ileostomy or colostomy includes: assisting the patient and/or SO during the adjustment, preventing complications, supporting independence in self-care, providing 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. Risk for Sexual Dysfunction
  5. Risk for Constipation or Diarrhea

Nursing Diagnosis

  • Risk for Impaired Skin Integrity

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

  • Client will maintain skin integrity around the stoma.
  • Client will identify individual risk factors.
  • Client will demonstrate behaviors/techniques to promote healing/prevent skin breakdown.
Nursing Interventions Rationale
Inspect 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 stoma may be from a pouch opening that is too small or a faceplate that cuts into stoma. In patients with an ileostomy, the effluent is rich in enzymes, increasing the likelihood of skin irritation. In patient with a colostomy, skin care is not as great a concern because the enzymes are no longer present in the effluent.
Clean with warm water and pat dry. Use soap only if area is covered with sticky stool. If paste has collected on the skin, let it dry, then peel it off. Maintaining a clean and dry area helps prevent skin breakdown.
Measure stoma periodically: at least weekly for first 6 wk, then once a month for 6 mo. Measure both width and length of stoma. As postoperative edema resolves (during first 6 wk), the stoma shrinks and size of 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.
Verify that opening on 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 pouch. Prevents trauma to the stoma tissue and protects the peristomal skin. Adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis.
Use a transparent, odor-proof drainable pouch. A transparent appliance during first 4–6 wk allows easy observation of stoma without necessity of removing pouch/irritating skin.
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 pouch when necessary. Note: Sigmoid colostomy may not require use of a skin barrier once stool becomes formed and elimination is regulated through irrigation.
Empty, irrigate, and cleanse 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.
Support surrounding skin when gently removing appliance. Apply adhesive removers as indicated, then wash thoroughly. Prevents tissue irritation or destruction associated with “pulling” pouch off.
Investigate reports of burning, itching, or blistering around stoma. Indicative of effluent leakage with peristomal irritation, or possibly Candida infection, requiring intervention.
Evaluate adhesive product and appliance fit on ongoing basis. Provides opportunity for problem solving. Determines need for further intervention.
Consult with certified wound, ostomy, continence nurse. Helpful in choosing products appropriate for patient’s particular rehabilitation needs, including type of ostomy, physical/mental status, abilities to handle self-care, and financial resources.
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.

Nursing Diagnosis

  • Disturbed Body Image

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

  • 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 Interventions Rationale
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.

Nursing Diagnosis

  • Acute Pain

May be related to

  • Physical factors: e.g., disruption of skin/tissues (incisions/drains)
  • Biological: activity of disease process (cancer, trauma)
  • Psychological factors: e.g., fear, anxiety

Possibly evidenced by

  • Reports of pain, self-focusing
  • Guarding/distraction behaviors, restlessness
  • Autonomic responses, e.g., changes in vital signs

Desired Outcomes

  • Client will verbalize that pain is relieved/controlled.
  • Client will display relief of pain, able to sleep/rest appropriately
  • Client will demonstrate the use of relaxation skills and general comfort measures as indicated for an individual situation.
Nursing Interventions Rationale
Assess pain, noting location, characteristics, intensity (0–10 scale). Helps evaluate the degree of discomfort and effectiveness of analgesia or may reveal developing complications. Because abdominal pain usually subsides gradually by the third or fourth postoperative day, continued or increasing pain may reflect delayed healing or peristomal skin irritation. Note: Pain in the anal area associated with abdominal-perineal resection may persist for months.
Encourage patient to verbalize concerns. Active-listen these concerns, and provide support by acceptance, remaining with the patient, and giving appropriate information. Reduction of anxiety/fear can promote relaxation or comfort.
Provide comfort measures, e.g., mouth care, back rub, repositioning (use proper support measures as needed). Assure patient that position change will not injure stoma. Prevents drying of oral mucosa and associated discomfort. Reduces muscle tension, promotes relaxation, and may enhance coping abilities.
Encourage use of relaxation techniques, e.g., guided imagery, visualization. Provide diversional activities. Helps patient rest more effectively and refocuses attention, thereby reducing pain and discomfort.
Assist with ROM exercises and encourage early ambulation. Avoid prolonged sitting position. Reduces muscle/joint stiffness. Ambulation returns organs to normal position and promotes the return of usual level of functioning. Note: Presence of edema, packing, and drains (if perineal resection has been done) increases discomfort and creates a sense of needing to defecate. Ambulation and frequent position changes reduce perineal pressure.
Investigate and report abdominal muscle rigidity, involuntary guarding, and rebound tenderness. Suggestive of peritoneal inflammation, which requires prompt medical intervention.
Administer medication as indicated, e.g., narcotics, analgesics, patient-controlled analgesia (PCA). Relieves pain, enhances comfort, and promotes rest. PCA may be more beneficial, especially following anal-perineal repair.
Provide sitz baths. Relieves local discomfort, reduces edema, and promotes healing of perineal wound.
Apply/monitor the effects of transcutaneous electrical nerve stimulator (TENS) unit. Cutaneous stimulation may be used to block transmission of the pain stimulus.

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

  • 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.

Nursing Diagnosis

  • Constipation
  • Diarrhea

Risk factors may include

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

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

  • Client will establish an elimination pattern suitable to physical needs and lifestyle with the effluent of appropriate amount and consistency.
Nursing Interventions Rationale
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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