Nursing Process for Colostomy Care
Nurses play a crucial role in the care of patients undergoing colostomy surgery, both pre-operatively and post-operatively. This includes educating patients and their families, providing immediate post-operative care, and ensuring ongoing support for patients managing long-term ostomies. A key aspect of nursing care is the identification of appropriate nursing diagnoses to guide individualized care plans.
Nursing Care Plans for Colostomy
Nursing care plans are essential tools for prioritizing care and implementing effective interventions for patients with colostomies. These plans are based on identified nursing diagnoses and help to achieve both short-term and long-term patient goals. Below are examples of common nursing diagnoses relevant to colostomy care, providing a framework for developing comprehensive care plans.
Deficient Knowledge related to Colostomy Care
Adapting to life with a colostomy involves a significant learning curve for patients. Understanding how to manage and care for their ostomy is crucial for their physical and psychological well-being.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Unfamiliarity with colostomy and its management
- Limited prior exposure to ostomy care
- Cognitive barriers to learning
- Lack of perceived need for information
As evidenced by:
- Expressed lack of understanding regarding colostomy care procedures
- Inability to accurately describe colostomy care techniques
- Demonstration of incorrect ostomy care practices
- Development of preventable complications related to ostomy management
Expected Outcomes:
- Patient will accurately demonstrate the correct procedure for emptying, cleaning, and applying a colostomy pouching system.
- Patient will verbalize appropriate dietary modifications to manage stool consistency and output.
- Patient will identify potential signs and symptoms of colostomy complications requiring prompt medical attention.
Assessment:
1. Evaluate the patient’s current understanding of colostomy care. Assess the patient’s existing knowledge about the purpose of their colostomy, proper care techniques, and potential complications. Identify any misconceptions or knowledge gaps.
2. Determine the patient’s learning capabilities and support system. Consider the patient’s cognitive function, literacy level, and any physical limitations that may affect their ability to learn and perform ostomy care. Assess the availability of family or caregiver support to assist with education and care.
Interventions:
1. Build patient confidence in their ability to manage their colostomy. Provide positive reinforcement and encouragement as the patient learns ostomy care. Break down complex tasks into smaller, manageable steps to promote a sense of accomplishment and build self-efficacy.
2. Provide comprehensive education on all aspects of colostomy care. Educate the patient on pouch emptying techniques (when the pouch is 1/3 to 1/2 full), pouch changing procedures, skin care around the stoma, bathing with a colostomy, dietary guidelines to minimize gas and odor, and strategies for managing lifestyle adjustments.
3. Educate on the recognition and management of potential colostomy complications. Instruct the patient on signs and symptoms of complications such as stoma prolapse, retraction, skin irritation, infection, and bowel obstruction. Emphasize the importance of contacting their healthcare provider promptly if any concerns arise.
4. Facilitate hands-on practice and return demonstration of colostomy care. Provide opportunities for the patient to practice emptying, cleaning, and changing their colostomy pouch under supervision. Observe the patient’s technique and provide constructive feedback to ensure competency.
5. Collaborate with an ostomy nurse specialist. Refer the patient to a certified ostomy nurse for specialized education and support. Ostomy nurses possess advanced knowledge and skills in ostomy management and can provide valuable resources and guidance.
Disturbed Body Image related to Colostomy
The presence of a colostomy can significantly alter a patient’s perception of their body, leading to feelings of self-consciousness, anxiety, and distress.
Nursing Diagnosis: Disturbed Body Image
Related to:
- Changes in body appearance due to the stoma
- Loss of bowel control and altered bodily function
- Perceived or actual negative reactions from others
- Impact on sexual intimacy and relationships
- Lifestyle adjustments and limitations
As evidenced by:
- Verbalization of negative feelings about body appearance or function
- Expressed concerns about sexuality, intimacy, and social acceptance
- Avoidance of looking at or touching the stoma
- Refusal to participate in ostomy care
- Social withdrawal and isolation
Expected Outcomes:
- Patient will begin to express comfort with their altered body image, as evidenced by willingness to look at and participate in stoma care.
- Patient will verbalize acceptance of changes in body image and incorporate the ostomy into their self-concept.
- Patient will actively seek information and resources to adapt to life with a colostomy and address body image concerns.
Assessment:
1. Assess the patient’s support system and social network. Determine the level of support available from family, friends, or partners. A strong support system is crucial for coping with body image changes.
2. Consider age and lifestyle factors influencing body image. Recognize that body image concerns may be more pronounced in younger, more active individuals. Assess how the colostomy may impact the patient’s lifestyle and self-perception based on their age, occupation, and social roles.
3. Observe patient’s behaviors and emotional responses related to their ostomy. Monitor the patient’s willingness to look at, touch, or care for their stoma. Observe for signs of withdrawal, anxiety, or negative self-talk related to their body image.
Interventions:
1. Maintain a positive and accepting approach during colostomy care. Demonstrate confidence and a matter-of-fact attitude when providing ostomy care. Avoid any nonverbal cues of disgust or negativity that could reinforce the patient’s negative body image.
2. Help the patient envision a fulfilling life with a colostomy. Reassure the patient that a colostomy does not have to limit their activities or quality of life. Provide examples of individuals living full and active lives with ostomies. Discuss strategies for concealing the ostomy and managing daily activities.
3. Facilitate connection with ostomy support groups. Recommend joining a local or online ostomy support group. Peer support can be invaluable in helping patients adjust to body image changes and learn coping strategies from others with shared experiences.
4. Recommend professional counseling or therapy. If the patient is struggling with significant body image distress, depression, or anxiety related to their colostomy, suggest counseling or therapy with a mental health professional experienced in body image and adjustment issues.
Dysfunctional Gastrointestinal Motility related to Colostomy
Colostomy surgery can disrupt normal gastrointestinal function, potentially leading to motility issues.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Surgical manipulation of the bowel
- Postoperative ileus
- Underlying disease process affecting bowel function
- Medications
- Dietary factors
As evidenced by:
- Abdominal distension and discomfort
- Changes in bowel sounds (hypoactive or hyperactive)
- Altered stool frequency or consistency (diarrhea or constipation)
- Increased stoma output or lack of output
- Nausea and vomiting
- Abdominal cramping
Expected Outcomes:
- Patient will demonstrate return to normal or acceptable bowel motility patterns.
- Patient will be free from symptoms of dysfunctional gastrointestinal motility such as excessive gas, diarrhea, or constipation.
- Patient will not experience complications related to dysfunctional gastrointestinal motility, such as intestinal obstruction.
Assessment:
1. Monitor for postoperative ileus. Assess for signs and symptoms of postoperative ileus, including nausea, vomiting, abdominal distension, abdominal pain, and delayed passage of flatus or stool. Postoperative ileus is a common temporary condition following bowel surgery.
2. Auscultate and assess bowel sounds. Regularly assess bowel sounds for presence, frequency, and character. Decreased or absent bowel sounds may indicate reduced gastrointestinal motility.
3. Evaluate dietary intake and tolerance. Assess the patient’s dietary intake, including fluid intake and fiber content. Identify any foods that may be contributing to gastrointestinal motility issues, such as diarrhea or gas.
Interventions:
1. Administer intravenous fluids as prescribed. IV fluids are often necessary to maintain hydration and electrolyte balance, especially in cases of postoperative ileus or high stoma output.
2. Encourage a diet appropriate for colostomy function. Initially, a low-fiber diet may be recommended to reduce stool output and allow the bowel to heal. Gradually introduce soluble fiber-rich foods like bananas, applesauce, and oats to promote stool formation and regulate motility. Advise the patient to avoid foods known to cause gas or diarrhea.
3. Monitor fluid and electrolyte balance. Closely monitor for signs of fluid and electrolyte imbalances, particularly sodium and potassium, especially in patients with high stoma output. Report any abnormalities to the physician.
4. Promote early ambulation. Encourage early and frequent ambulation as tolerated. Ambulation helps stimulate bowel motility and can aid in the resolution of postoperative ileus.
5. Administer medications as ordered. Administer medications such as anti-diarrheals or anti-motility agents as prescribed to manage symptoms of dysfunctional gastrointestinal motility. Administer prokinetic medications, if ordered, to promote gastric emptying and intestinal motility.
Ineffective Tissue Perfusion at the Stoma Site
Compromised blood supply to the stoma can lead to serious complications.
Nursing Diagnosis: Ineffective Tissue Perfusion (Stoma)
Related to:
- Surgical trauma and edema
- Compromised circulation
- Tension on mesenteric vessels
- Underlying vascular disease
- Stoma constriction
As evidenced by:
- Dusky, pale, or cyanotic stoma color
- Cold stoma to touch
- Stoma retraction or prolapse
- Edema or unusual swelling of the stoma
- Absence of or minimal stomal bleeding with manipulation
Expected Outcomes:
- Patient will maintain adequate tissue perfusion to the stoma, as evidenced by a healthy pink or red stoma color and appropriate stoma function.
- Patient will be free from signs and symptoms of stoma necrosis or ischemia.
- Patient will experience timely identification and intervention for any perfusion-related stoma complications.
Assessment:
1. Regularly assess stoma appearance and characteristics. Inspect the stoma at least every shift, noting color, size, edema, and any signs of retraction or prolapse. A healthy stoma should be pink to red, moist, and slightly raised above skin level.
2. Evaluate stoma viability. Assess stoma color and temperature. A dusky, pale, or cyanotic stoma may indicate compromised blood supply. Gently manipulate the stoma and observe for bleeding, which suggests adequate perfusion. Absence of bleeding upon manipulation is concerning.
3. Monitor for signs of stoma complications. Assess for signs of stoma retraction (stoma pulling below skin level) or prolapse (stoma protruding excessively above skin level), which can compromise perfusion.
Interventions:
1. Implement routine stoma monitoring protocols. Establish a schedule for regular stoma assessments to detect early signs of perfusion compromise. Document stoma appearance, color, size, and any abnormalities.
2. Ensure proper pouching system application. Verify that the pouching system is appropriately sized and applied to avoid pressure or constriction around the stoma, which could impair circulation.
3. Educate the patient on stoma observation and reporting. Instruct the patient to regularly observe their stoma and report any changes in color, size, or appearance to their healthcare provider immediately.
4. Promote adequate hydration and circulation. Encourage adequate fluid intake to maintain hydration and blood volume, which are essential for tissue perfusion. Encourage ambulation as tolerated to promote circulation.
5. Report any signs of impaired stoma perfusion promptly. Immediately report any findings suggestive of ineffective tissue perfusion, such as a dusky or cyanotic stoma, to the surgeon or healthcare provider for prompt intervention.
Risk for Impaired Skin Integrity related to Peristomal Skin
The skin surrounding the stoma is vulnerable to irritation and breakdown due to exposure to stool and pouching system adhesives.
Nursing Diagnosis: Risk for Impaired Skin Integrity
Related to:
- Exposure to irritating stool effluent
- Moisture and friction under the pouching system
- Allergic reactions to pouching materials
- Improper pouching system fit or application
- Frequent pouch changes or aggressive skin cleaning
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are focused on prevention.
Expected Outcomes:
- Patient will maintain intact peristomal skin, free from redness, irritation, or breakdown.
- Patient will demonstrate proper techniques for pouching system application and skin care to protect peristomal skin integrity.
- Patient will verbalize preventive measures to minimize the risk of peristomal skin irritation.
Assessment:
1. Regularly inspect the peristomal skin. Assess the skin surrounding the stoma at each pouch change for any signs of redness, irritation, erosion, or breakdown. Early detection allows for prompt intervention.
2. Assess pouching system fit and application. Evaluate the fit of the wafer (skin barrier) and the pouch. Ensure the wafer is appropriately sized and adhered securely to prevent leakage of stool onto the skin.
3. Identify potential irritants or allergens. Assess for potential irritants in skin care products or allergies to pouching system materials (e.g., adhesives, wafers). Inquire about any history of skin sensitivities or allergies.
Interventions:
1. Implement gentle skin cleansing practices. Cleanse the peristomal skin gently with warm water and a soft cloth or disposable wipes during pouch changes. Avoid harsh soaps or scrubbing, which can irritate the skin. Ensure the skin is completely dry before applying a new pouch.
2. Utilize skin barrier products. Apply a skin barrier film or paste to protect the peristomal skin from stool and adhesives. Skin barriers create a protective layer and can improve pouch adherence.
3. Ensure proper pouching system fit. Measure the stoma regularly, especially in the initial postoperative period, and cut the wafer opening to the correct size (approximately 1/8 inch larger than the stoma). A properly fitted wafer minimizes skin exposure to stool.
4. Educate the patient on preventative skin care measures. Instruct the patient on proper pouching techniques, skin care routines, and strategies to prevent peristomal skin complications. Emphasize the importance of gentle skin cleansing, using skin barrier products, and ensuring proper pouch fit.
5. Limit unnecessary pouch changes. Educate the patient that routine pouch changes should be done every 3-7 days, or as needed, rather than daily, unless leakage occurs. Frequent pouch changes can increase skin irritation.
By utilizing these nursing diagnoses and implementing tailored care plans, nurses can significantly improve the outcomes and quality of life for patients undergoing colostomy surgery and living with a colostomy.
Alt text: Nurse demonstrating application of a colostomy pouching system to a patient’s abdomen, highlighting proper technique for secure and skin-friendly adhesion.
Alt text: Surgeon marking the pre-operative site for colostomy stoma placement on a patient’s abdomen to ensure optimal location and accessibility.
Alt text: Close-up view of a gloved hand emptying the contents of a colostomy bag into a toilet, illustrating a key step in routine colostomy care and waste management.
References
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- Colostomy and ileostomy. (n.d.). Canadian Cancer Society. Retrieved April 20, 2022, from https://cancer.ca/en/treatments/tests-and-procedures/colostomy-and-ileostomy
- 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.
- 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/
- 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
