Nursing Care Plan on Colostomy & Ileostomy - Nurseslab.in (2025)

Colostomy and ileostomy are surgical procedures that create an opening from the intestines through the abdominal wall, known as a stoma. One difference is the part of the bowel that is used. Acolostomyuses part of the colon while anileostomyuses part of the ileum.

Both procedures can be temporary or permanent depending on the reason they are needed. Conditions that may require a colostomy or ileostomy include:

• Cancer of the colon, rectum, or anus
• Ulcerative colitis
• Crohn’s disease
• Bowel obstructions
• Diverticulitis

After a colostomy or ileostomy surgery, the patient will no longer have control of their bowel movements and will have to wear a pouch system over their stoma. Living with an ostomy will require adapting to changes in lifestyle habits, diet, and sexual intimacy.

Nursing Process

Nurses may assist patients who are undergoing surgery for a colostomy/ileostomy and will be responsible for providing education and immediate care post-op. For patients with long-term ostomies, the nurse can assist with reinforcing education and ensuring the patient is caring for their ostomy correctly to prevent complications.

Nursing Assessment

A thorough nursing assessment is essential to develop an effective care plan for patients with colostomies and ileostomies. This involves evaluating both the physical condition of the stoma and the patient’s overall health and psychological status.

Physical Assessment

Stoma Evaluation: Nurses regularly inspect the stoma to ensure it is pink, moist, and free from signs of infection or necrosis. They assess the size, shape, and output of the stoma, noting any changes.

Peristomal Skin Assessment: The skin around the stoma is checked for irritation, redness, or breakdown, which could indicate leakage or improper fitting of the ostomy appliance.

Output Monitoring: Nurses monitor the quantity, consistency, and odor of the fecal or urinary output from the stoma. This helps in assessing the patient’s hydration status and the effectiveness of their diet and medications.

Vital Signs Monitoring: Regular monitoring of vital signs, including blood pressure, heart rate, and temperature, helps in detecting any complications such as dehydration, infection, or electrolyte imbalances.

Psychosocial Assessment

Emotional Well-being: Nurses assess the patient’s emotional response to their colostomy or ileostomy, providing support and counseling as needed. They address any feelings of anxiety, depression, or body image concerns.

Patient Education: Assessing the patient’s knowledge of stoma care is crucial. Nurses ensure that patients comprehend the instructions for proper stoma care, appliance management, and recognizing signs of complications.

Nursing Interventions

Effective nursing interventions are vital to ensure the well-being and quality of life of patients with colostomies and ileostomies. These interventions encompass physical care, patient education, and emotional support.

Physical Care

Stoma Care: Nurses teach patients how to clean the stoma and surrounding skin, change the ostomy appliance, and ensure proper fit to prevent leaks and skin irritation.

Dietary Management: Providing dietary advice to help patients manage their stoma output and prevent complications such as blockages, diarrhea, or excessive gas.

Hydration and Electrolyte Balance: Nurses educate patients on the importance of staying hydrated and monitoring their electrolyte levels, particularly for those with ileostomies, who are at higher risk of dehydration.

Patient Education

Self-Care Training: Empowering patients with the knowledge and skills to manage their stoma independently, including troubleshooting common issues and knowing when to seek medical help.

Signs of Complications: Educating patients about signs of potential complications, such as infection, blockage, or changes in stoma appearance, and advising them to seek prompt medical attention if these occur.

Emotional Support

Active Listening: Offering a listening ear to patients’ concerns and fears, validating their feelings, and providing reassurance.

Counseling Referrals: Referring patients to professional counselors or support groups if needed, to provide additional emotional and psychological support.

Family Involvement: Engaging family members in the care process, providing them with necessary information, and supporting them as they assist the patient.

Nursing Care Plans

Once the nurse identifiesnursing diagnosesfor colostomy and ileostomy,nursing care planshelp prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for colostomy and ileostomy.

Deficient Knowledge

Preparing for, adapting to, and managing an ostomy can present a large learning curve.

Nursing Diagnosis:Deficient Knowledge

Related to:

• Lack of exposure/unfamiliarity with colostomy/ileostomy
• Cognitive limitation
• Lack of interest in ostomy care

As evidenced by:

• Inability to recall or demonstrate ostomy care
• Verbalizes incorrect/inaccurate statements regarding colostomy/ileostomy
• Develops a complication due to lack of knowledge

Expected outcomes:

• Patient will demonstrate the ability to remove, clean, and reapply a new ostomy device.
• Patient will verbalize dietary changes to control stool output.
• Patient will recognize signs of a complication and seek immediate assistance.

Assessment:

1. Assess understanding and capability.
Review education regarding the need for a colostomy/ileostomy and how to care for it. Assess the patient’s developmental level and cognition to ensure understanding and ability to perform necessary care.

2. Assess for family assistance.
Depending on the aforementioned assessment, the patient may require support from family. If the patient is too young, disabled, or unable to follow directions, provide education to an involved family member.

Interventions:

1. Encourage confidence in the patient.
Patients may lack confidence in performing ostomy care. Boost confidence by having them participate in care and providing positive feedback.

2. Educate on ostomy care.
Ensure the patient understands to empty their pouch when it is ⅓-½ full to prevent pouch loosening. Educate on how to bathe, how to prevent gas and odors by not eating certain foods and other nuances.

3. Manage complications.
Complications such as bowel obstructions, diarrhea, and short bowel syndrome can develop. Educate the patient on signs and symptoms and when to contact their provider.

4. Have the patient demonstrate.
The best way to ensure ostomy teaching has been effective is to observe the patient perform emptying, cleaning, and changing their ostomy system.

5. Coordinate with an ostomy nurse.
A nurse who specializes in ostomy care is a wealth of information in teaching the patient all about their colostomy and ileostomy. The nurse can also recommend supplies that can make managing their ostomy easier.

Disturbed Body Image

An ostomy is a major physical change that can result in psychological distress and affect the patient’s self-confidence and relationships.

Nursing Diagnosis:Disturbed Body Image

Related to:

• Alteration in appearance
• Loss of control over bowel movements
• Major lifestyle changes (bathroom habits, clothing choices, exercise)

As evidenced by:

• Verbalization of concerns in appearance, sexuality, relationships, lifestyle changes
• Negative self-concept
• Refusal to participate in ostomy care
• Chosenisolation from socialization

Expected outcomes:

• Patient will begin to demonstrate comfort with body image as evidenced by viewing/touching ostomy and performing stoma care.
• Patient will verbalize acceptance of change in body image.
• Patient will seek information on navigating life with an ostomy.

Assessment:

1. Assess family/spousal support.
A supportive family and/or spouse is vital in helping the patient cope with this new change. Involve their support system only if the patient is comfortable doing so.

2. Note age and lifestyle factors.
While an ostomy can be difficult to navigate at any age, the physical change is usually more traumatic for those who are younger and more active.

3. Observe behavior and withdrawal.
Observe the patient’s response to their ostomy and if they are willing to look at it, participate in care, or seek information. Patients may need time to adapt.

Interventions:

1. Take a positive approach.
Always provide ostomy care with confidence and a positive attitude. Never show facial expressions of disgust so as not to cause further harm to the patient’s ego.

2. Help the patient visualize a normal life.
Living with an ostomy does not have to affect everyday activities. Patients may be relieved to learn that they can still wear clothing they prefer, eat the foods they love, and participate in sports such as swimming or weight lifting. Remind the patient there are many ways to hide their ostomy if they prefer.

3. Consider a support group.
Adapting to a colostomy or ileostomy takes time. Talking to others with ostomies who understand the difficulties can be empowering. Support groups may be in person or online and can provide tips and advice to ease the transition.

4. Recommend counselling.
Depressionand anger can develop and the patient may grieve their loss of appearance. A patient struggling with acceptance of their body image may require counselling to overcome challenges to their lifestyle and intimacy.

Dysfunctional Gastrointestinal Motility

Surgical procedures like colostomy and ileostomy can affect the nerves and muscles of the gastrointestinal tract, causing disruption in normal gastrointestinal functions like nutrient and water absorption in the affected area, dysfunction in gastrointestinal motility, and an increase in the risk of developing intestinal obstruction.

Nursing Diagnosis: Dysfunctional Gastrointestinal Motility

Related to:

• Disease process
• Inflammatory process
• Surgical intervention
• Colostomy placement
• Ileostomy placement

As evidenced by:

• Abdominal cramping
• Abdominal pain
• Hypoactive bowel sounds
• Diarrhea
• Increased gastric residual
• Constipation
• Gas
• Nausea
• Vomiting
• Accelerated gastric emptying

Expected outcomes:

• Patient will be free from any signs of dysfunctional gastrointestinal motility like diarrhea, gas, and changes in bowel habits.
• Patient will show no signs of intestinal obstruction and postoperative ileus.

Assessment:

1. Assess for postoperative ileus after colostomy or ileostomy.
Postoperative ileus is characterized by a temporary delay in gastrointestinal motility and is not uncommon after colon or rectal surgery. Its signs and symptoms include nausea, vomiting,abdominal pain, abdominal distention, and delayed passage of stool and flatus.

2. Assess bowel sounds and their characteristics.
Inspect and auscultate the patient’s bowel sounds and percuss and palpate the abdomen. Decreased bowel sounds can indicate reduced gastrointestinal motility and ileus.

3. Assess the patient’s diet.
For several weeks after surgery, the patient will need to eat soft, low-fiber foods to avoid diarrhea, bloating, and gas. Over time, the patient can return to a regular diet. An ileostomy is more prone to blockages since it involves the small intestine. The patient with an ileostomy should avoid insoluble fiber and eat more soluble fiber to prevent diarrhea and gas.

Interventions:

1. Administer IV fluids.
Postoperative ileus is often resolved through supportive measures such asIV fluidand electrolyte replacement.

2. Encourage adequate intake of soluble fiber.
After colostomy or ileostomy, a diet high in soluble fiber, like apples, bananas, oats, rye, and barley, is recommended as this can significantly improve motility problems. Instruct the patient to avoid foods rich in insoluble fiber like bran, cereals, legumes, dried beans, and certain fruits and vegetables.

3. Monitor the patient for signs and symptoms of fluid and electrolyte imbalance.
As peristalsis returns after an ileostomy or colostomy procedure, drainage in the stoma can increase (high output) as the patient has lost the absorptive function of some parts of the intestines. The patient must be monitored for fluid andelectrolyte deficits, especially sodium and potassium.

4. Encourage ambulation.
Early ambulation is very important following bowel resection to prevent or reduce ileus and promote bowel motility.

5. Administer medications as indicated.
Medications like antidiarrheals and antimotility medications that reduce stoma output or gut secretions may be indicated to slow bowel motility in patients experiencing high stoma output after colostomy or ileostomy procedures. Antimotility medications should be administered before meals for optimal effects through counteracting postprandial hypermotility.

Ineffective Tissue Perfusion

Complications of ostomy procedures include tissue perfusion problems like ischemia, necrosis, dehydration, nutrient malabsorption, bleeding, stoma complications,infection, and inflammation.

Nursing Diagnosis:Ineffective Tissue Perfusion

Related to:

• Impaired skin integrity
• Inadequate primary defenses
• Underlying disease process
• Inflammatory process
• Intestinal obstruction
• Altered circulation
• Delayed healing

As evidenced by:

• Dusky, purple stoma
• Bleeding stoma
• Prolapsed stoma
• Retracted stoma
• Abdominal pain
• Peristomal irritation

Expected outcomes:

• Patient will be free from any signs of necrosis and infection at the stoma site.
• Patient will be free from any perfusion complications includingbleeding, infection, and inflammation.

Assessment:

1. Assess the stoma and the surrounding area.
The stoma is expected to be moist, pink to red, and above skin level, and the surrounding area must not exhibit signs of irritation, infection, and inflammation. The stoma is measured regularly and will be swollen for 6-8 weeks following surgery.

2. Inspect for any signs of potential stoma complications.
A prolapsed stoma is the abnormal protrusion of the stoma from the abdominal wall. Retraction of the stoma into the abdomen is also abnormal.

3. Assess for signs of bleeding.
Post-surgical bleeding can occur within the first 48 hours after a colostomy or ileostomy and requires further investigation. Bleeding that stops after several minutes with slight pressure is likely superficial. Frank blood or oozing blood requires alerting the surgeon to perform cauterization, suture placement, or ligation.

Interventions:

1. Initiate routine stoma monitoring.
Pallor, duskiness, or necrosis can indicate poor perfusion requiring immediate intervention.

2. Instruct the patient to change the colostomy bag every 5-7 days.
Frequent colostomy pouch changes can cause skin irritation and perfusion problems and must be avoided. Routine colostomy pouch changes should be done every 5-7 days unless the pouch is leaking.

3. Take extra care when removing the pouching system from the surgical site.
An appropriate method for removing the pouching system involves pushing the skin away from the sticky barrier rather than pulling the sticky barrier from the skin. This technique prevents further impairment of the surrounding skin and reduces the incidence of ineffective tissue perfusion.

4. Encourage the patient to ambulate after the colostomy procedure as tolerated.
Early mobilization can help reduce postoperative ileus, promote adequate tissue perfusion, prevent inter-bowel adhesions, and prevent intestinal obstruction.

5. Encourage lifestyle modifications as indicated.
Stoma placement may be temporary or permanent. Patients can benefit from lifestyle modifications to nutrition, exercise, and smoking cessation to improve tissue perfusion, promote adequate circulation, reduce the risk of infection, and promote timely wound healing at the stoma site.

Risk for Impaired Skin Integrity

Since the stoma brings waste products through the abdominal wall, the risk of irritation to the surrounding skin is very high.

Nursing Diagnosis: Risk forImpaired Skin Integrity

Related to:

• Improper emptying of the pouch
• Diet changes affecting output
• Improper wafer fitting/application causing leakage
• Improper hygiene
• Delayed healing of the stoma

Note:A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred.Nursing interventionsare aimed at prevention.

Expected outcomes:

• Patient will demonstrate proper sizing and application of the wafer.
• Patient will display intact skin surrounding the stoma without redness or swelling.
• Patient will verbalize two strategies to prevent skin irritation.

Assessment:

1. Inspect the stoma and surrounding skin.
Assess for redness,bleeding, and rashes. Assess the stoma to ensure it is a beefy red color and measure it to monitor if it has retracted or is protruding. This is most important in the weeks following colostomy/ileostomy surgery.

2. Assess diet.
A low-residue diet may be prescribed for the first few months. Assess the foods the patient is eating that may be causing diarrhea and increased output, leading to skin irritation.

3. Assess for allergies.
Monitor for an allergy to barrier pastes, adhesives, and pouch systems. Sensitivities can develop even after months or years of using a product.

Interventions:

1. Clean and keep dry.
Keep the area surrounding the stoma free from stool. Use warm water and a washcloth or toilet paper to clean the area. Soap is usually not recommended. Ensure the area is completely dry before applying adhesives.

2. Apply a protective paste.
Pastes and powders can be used that assist the adhesive in fitting better to the skin, preventing leakage.

3. Measure the wafer.
The wafer, or skin barrier, attaches the pouch to the skin. Wafers should be measured correctly so they are not too tight or too loose around the stoma. This is accomplished by measuring the stoma and then cutting the wafer so that it is no larger than 1/16 to ⅛ the diameter of the stoma.

4. Provide education on the pouch system.
Ensure the patient understands that frequent changing of the pouch is irritating to the skin. This should only be done every few days. Educate to take care when removing the pouch so as not to pull on the skin.

Nursing Diagnoses and Rationale for Colostomy and Ileostomy

1. Risk for Impaired Skin Integrity

Rationale: The stoma and surrounding skin are at high risk for irritation and breakdown due to continuous exposure to stool and digestive enzymes. Nurses should regularly assess the skin around the stoma for signs of redness, swelling, and breakdown. Implementing appropriate skin care regimens, using barrier creams, and ensuring proper fitting of ostomy appliances can help maintain skin integrity and prevent complications.

2. Risk for Infection

Rationale: The presence of an external stoma increases the risk of infection, especially if proper hygiene is not maintained. Nurses should educate patients and caregivers about the importance of hand hygiene, proper cleaning techniques, and the signs of infection, such as excessive redness, swelling, pain, or discharge. Prompt identification and treatment of infections are vital to prevent further complications.

3. Disturbed Body Image

Rationale: The creation of a stoma can significantly alter a patient’s body image and self-esteem, leading to feelings of embarrassment, shame, and decreased confidence. Nurses should provide emotional support and counselling, helping patients to adapt to their new body image and encouraging participation in support groups where they can share experiences and coping strategies with others facing similar challenges.

4. Ineffective Coping

Rationale: Adjusting to life with a stoma can be overwhelming and may lead to ineffective coping mechanisms, such as denial, withdrawal, or depression. Nurses should assess patients’ coping strategies and provide education on healthy coping mechanisms. Referrals to mental health professionals and support groups can help patients develop effective ways to manage their emotions and adapt to their new circumstances.

5. Risk for Nutritional Imbalance

Rationale: Changes in bowel function and the absorption of nutrients following a colostomy or ileostomy can lead to nutritional imbalances. Nurses should monitor patients’ dietary intake, weight, and laboratory values to identify any deficiencies or excesses. Providing dietary counseling and collaborating with a dietitian can help patients maintain a balanced diet and prevent malnutrition.

6. Risk for Fluid and Electrolyte Imbalance

Rationale: An ileostomy, in particular, can result in significant fluid and electrolyte loss due to the bypassing of the colon, where water and electrolytes are typically absorbed. Nurses should monitor fluid intake and output, as well as laboratory values, to detect any imbalances early. Educating patients about the importance of adequate hydration and electrolyte replacement is essential for preventing complications such as dehydration and electrolyte disturbances.

7. Impaired Physical Mobility

Rationale: Postoperative pain, weakness, and the presence of a stoma can limit a patient’s physical mobility. Nurses should encourage gradual mobilization, provide pain management strategies, and offer assistive devices as needed. Physical therapy referrals can also support patients in regaining strength and mobility.

8. Risk for Constipation or Diarrhoea

Rationale: Changes in bowel habits are common after colostomy or ileostomy surgery. Nurses should assess patients’ bowel patterns and provide education on managing constipation or diarrhoea through dietary modifications, hydration, and the use of medications when necessary.

9. Risk for Sexual Dysfunction

Rationale: The presence of a stoma can affect a patient’s sexual function and intimacy. Nurses should provide sensitive and nonjudgmental support, addressing any concerns or questions patients may have about their sexual health. Referrals to sexual health counsellors or therapists can also be beneficial.

10. Knowledge Deficit

Rationale: Patients and their caregivers may have limited knowledge about managing a colostomy or ileostomy. Nurses should provide comprehensive education on stoma care, potential complications, lifestyle adjustments, and available resources. Patient education should be ongoing and tailored to individual needs, ensuring that patients feel confident and competent in managing their condition.

REFERENCES

1. Ostomy: Adapting to life after colostomy, ileostomy or urostomy. (2020, November). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825
2. American Cancer Society. (2019, October 16). Caring for a Colostomy. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html
3. Colostomy and ileostomy. (n.d.). Canadian Cancer Society. https://cancer.ca/en/treatments/tests-and-procedures/colostomy-and-ileostomy
4. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
5. Maria A, Lieske B. Colostomy Care. [Updated 2021 Sep 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK560503/

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