A nurse is reinforcing teaching with a client about replacing an ostomy pouching system

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. A colostomy uses part of the colon while an ileostomy uses 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. 

The 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 Care Plans For Colostomy and Ileostomy 

Risk For Impaired Skin Integrity Care Plan 

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

Nursing Diagnosis: Risk For Impaired 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 interventions are 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 

Risk For Impaired Skin Integrity 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.

Risk For Impaired Skin Integrity 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.

Disturbed Body Image Care Plan 

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 
• Chosen isolation from socialization 

Expected Outcome: 

• 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 

Disturbed Body Image 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.

Disturbed Body Image 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 counseling.
Depression and anger can develop and the patient may grieve their loss of appearance. A patient struggling with acceptance of their body image may require counseling to overcome challenges to their lifestyle and intimacy.

Deficient Knowledge Care Plan  

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 

Deficient Knowledge 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.

Deficient Knowledge 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.

References and Sources

1. American Cancer Society. (2019, October 16). Caring for a Colostomy. American Cancer Society. Retrieved April 20, 2022, from https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html
2. Colostomy and ileostomy. (n.d.). Canadian Cancer Society. Retrieved April 20, 2022, from https://cancer.ca/en/treatments/tests-and-procedures/colostomy-and-ileostomy
3. 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.
4. 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/
5. Ostomy: Adapting to life after colostomy, ileostomy or urostomy. (2020, November). Mayo Clinic. Retrieved April 20, 2022, from https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825

How often should the pouching system be changed?

How do you change a pouching system for an ostomy?

What are three 3 Considerations The nurse would make in the care of a new ostomy?