What are Ileostomy and Colostomy

Ostomy is a surgical procedure that involves surgically creating an opening on the abdomen(stoma) to allow bodily waste to drain or pass through into a pouch prosthetic. An ileostomy is an opening at the end of the ileum, which is then diverted through the abdomen to the Skin’s surface, forming an opening known as the stoma. In most cases, an ileostomy is used to treat ulcerative and regional colitis and can be used to divert intestinal contents.

The diverted intestinal waste passes out of the ileostomy through the stoma and is collected by an ostomy system placed on the opening area. The removal of the entire anus, rectum, and colon makes the ostomy permanent. On the other hand, an ostomy is temporary when there is a need to promote bowel rest due to trauma or chronic colitis, among other cases.

Colostomy is the surgical process of diverting the colon through the abdomen and suturing it into place to create a stoma. A colostomy could be temporary or permanent, mainly done following bowel injury or surgery. A colostomy could be sigmoid, ascending, or transverse. A transverse colostomy is done in the upper abdomen at the middle or the right side of the colon, allowing stool to leave the body before descending at the colon. This surgery is mainly temporary and is mostly performed following a blockage, cancer, injury, perforated anus,  anal fistula, birth defects, diverticulitis, and inflammatory bowel disease. The sigmoid colostomy is usually permanent and is mainly done as treatment for cancer.

Nursing Care Plans for Ileostomy and Colostomy

Following an ileostomy or colostomy, the patient lacks full control of their bowel movement and has to wear a pouch at the stoma to help with stool drainage. In this case, the patient must adapt to a new lifestyle by changing their diet, habits, and sexual behavior. The goal of nursing care management and planning for patients who have undergone ileostomy and colostomy is to help them adjust, inform/teach required information about the disease and promote self-care. In addition, preventing complications is a major goal of nursing planning and management.

Nursing Care Plans and Nursing Diagnoses for Ileostomy and Colostomy (Ostomy)

The nursing diagnoses for Ileostomy and Colostomy include the following:

1. Risk for impaired skin integrity
2. Acute pain
3. Impaired skin integrity
4. Disturbed body image
5. Risk for sexual dysfunction
6. Risk for deficient fluid volume
7. Risk for imbalanced nutrition
8. Risk for constipation and diarrhea
9. Disturbed sleep pattern
10. Deficient knowledge

1.Ileostomy and Colostomy (Ostomy) Care Plan for Risk for Impaired Skin Integrity

The stoma created following an ileostomy or colostomy drains out waste through the abdominal wall to the pouch system. This increases the risk of skin irritation in the area surrounding the stoma, creating the need for effective nursing management.

Nursing Diagnosis

• Risk For Impaired Skin Integrity

Related to

• Improper wafer application leading to leakage of flatus and effluent from the stoma.
• Lack of sphincter at the opening (stoma).
• Reaction to chemical or improper care of the Skin.
• Improper emptying of the pouch.
• Delayed stoma healing.
• Improper hygiene.

Evidenced by

Note: A risk diagnosis does not have evidence of signs and symptoms since the problem is not there, and intervention focuses on intervention.

Desired Outcomes and Goals

• The patient will demonstrate proper application of the wafer.
• The skin around the stoma will remain intact with no swelling, rashes, or wounds.
• The patient will verbalize behaviors to prevent skin irritation.
• The patient will show knowledge of risk factors

Nursing Assessments and Rationales for Risk For Impaired Skin Integrity

The nursing assessment of a patient who has undergone ileostomy or colostomy with a risk for impaired skin integrity includes the following:

Nursing Assessment	Rationale
Inspect the stoma and the peristoma area after every change of pouch.	Assess the area for irritation signs, including rashes, redness, and bleeding. Regular monitoring of the stoma is crucial for effective treatment and prevention of complications. This will help promote timely treatment and prevention of serious problems. Ulcerations on the stoma area could indicate the use of a small pouch opening or the use of a faceplate that cut into the stoma.
Assess the characteristics of drainage.	Early identification of signs of ischemia or stomal necrosis and fungal infection due to changes in bowel flora could help address potential complications early.
Measure the stoma periodically, including its width and length. Measure frequently (weekly for the first six weeks), then once a month for six months.	As postoperative edema resolves, the stoma’s size shrinks in the first six weeks. This means the appliance size must be adjusted to ensure proper fit to collect effluent and prevent contact with skin effectively.
Investigate stoma area itching, burning, and blistering reports.	This could indicate leakage of effluent with irritation in the peristomal area. It could also indicate candida infection requiring immediate intervention.
Assess the patient for allergies.	Monitor patient allergies due to adhesives, barrier pasters, pouch systems, and other sensitivities after using different products.

Nursing Interventions and Rationales for Risk For Impaired Skin Integrity

The nursing intervention of a patient who has undergone ileostomy or colostomy with a risk for impaired skin integrity includes the following:

Nursing Intervention	Rationale
Clean the stoma and surrounding area with warm water and a washcloth. Keep the stoma area dry.	Keep the stoma area clean and stool-free to prevent skin breakdown and irritation. Keep the area completely dry before applying adhesive.
Apply the protective paste.	Applying pastes and powders help in fitting the adhesive to the Skin to prevent leakage.
Use a transparent and odor-proof pouch.	A transparent pouch in the first 6 weeks is crucial to help observe the drainage characteristics without the need to remove the pouch.
Apply the appropriate skin barrier to the stoma area (karaya gun, hydrocolloid wager, extended wear skin barrier).	This will protect the skin from pouch adhesive facilitating its removal while enhancing its adhesiveness.
Irrigate, empty, and clean the ostomy pouch routinely as indicated.	Since frequent changing of the pouch could cause skin irritation. In this case, irrigating the pouch helps remove odor, dirt, and bacteria, and deodorize it, which helps avoid irritation.
Apply the prescribed corticosteroid spray and antifungal powder as indicated.	This helps in healing and prevents fungal infection or heals one if it develops. The products should be used as indicated to avoid side effects.
Provide skin support when removing the appliance. Apply adhesive removers and wash the area thoroughly.	This will help prevent the destruction of the stoma and tissue irritation with pulling off the pouch.
Consult with a wound, continence, and an ostomy nurse.	This will help the patient in choosing appropriate products and promote self-care.
Provide education on the pouch system.	This will help the patients understand how to care for themselves, including removing and reattaching the pouch to avoid irritation or pulling on the Skin.

2.Ileostomy and Colostomy (Ostomy) Care Plan for Acute Pain

Nursing Diagnosis

• Acute Pain

Related to

• Skin or tissue disruption at the incision site.
• Disease process activity (trauma and cancer).

Evidenced by

• Pain reports from the patient.
• Self-focusing, guarding, and restlessness.
• Changes in vital signs (autonomic responses)

Desired Outcomes and Goals

• The patient will experience comfort, rest, and sleep appropriately.
• The patient will exhibit pain management skills and relaxation techniques.
• The patient will verbalize pain relief.

Nursing Assessments and Rationales for Acute Pain

The nursing assessment of a patient who has undergone ileostomy or colostomy with acute pain includes the following:

Nursing Assessment	Rationale
Assess the patient for pain intensity using a scale of 1-10, pain location, characteristic, pain period, and frequency.	This helps establish the discomfort degree. It will also help establish the effectiveness of pain management while allowing the nurse to identify developing complications. Since pain subsides gradually by the fourth day, continued and increasing pain could indicate skin irritation and delayed healing.
Investigate muscle rigidity in the abdominal area. Assess rebound tenderness and involuntary guarding.	This could indicate peritoneal inflammation requiring immediate intervention.

Nursing Interventions for Acute Pain

The nursing intervention of a patient who has undergone ileostomy or colostomy with acute pain includes the following:

Nursing Intervention	Rationale
Encourage the patient to speak in case of discomfort and actively listen to concerns, accept them, and provide support.	This will help reduce fear and anxiety, allowing the patient to feel comfortable and relaxed.
Offer the patient comfort measures, including back rub, oral care, and repositioning as needed. Assure the patient that the support measures, such as repositioning, will not affect the stoma.	Providing a back rub promotes relaxation, reduces muscle tension, and enhances the patient’s coping abilities. Oral care helps prevent oral mucosa drying and discomfort.
Encourage the patient to use various relaxation techniques, such as performing diversional techniques, guided imagery, and visualization.	This will help refocus the patient’s attention reducing pain and discomfort while allowing the patient to rest well.
Help the patient with range of motion (ROM) exercises to help achieve ambulation and improve motion.	This will help the patient return organs and tissues to normal position reducing joint and muscle stiffness. In addition, frequent position changes and ambulation will help reduce perineal pressure.

3.Impaired Skin Integrity

Nursing Diagnosis

• Impaired skin integrity

Related to

• Drainage or secretions stasis.
• Edema, malnutrition, and altered circulation.
• Perineal resection.

Evidenced by

• Altered skin or tissue and the presence of incision drains.

Desired Outcomes and Goals

• The patient will achieve wound healing with no disruption of skin integrity.

Nursing Assessments and Rationales

The nursing assessment of a patient who has undergone ileostomy or colostomy with impaired skin integrity includes the following:

Nursing Assessment	Rationale
Assess the wound for drainage and its characteristics.	Postoperative hemorrhage could occur in the first 2 days. An infection could develop at any time based on the type of wound closure.
Inspect the wound and stoma area for skin breakdown.	Skin breakdown could cause irritation and pain and require immediate intervention to prevent infection

Nursing Interventions and Rationales

The nursing intervention of a patient who has undergone ileostomy or colostomy with impaired skin integrity includes the following:

Nursing Intervention	Rationale
Change dressing as necessary and maintain asepsis.	Increased drainage requires frequent dressing changes to reduce skin irritation and prevent infection.
Encourage lying on the side with an elevated head and avoid prolonged sitting.	Side-lying promotes efficient drainage from perineal wounds. This reduces pooling risks and perineal pressure, which could cause healing delays.
Irrigate the wound as necessary and use diluted hydrogen peroxide, normal saline, or antibiotic solution.	This will help keep the stoma clean and prevent infection and intraoperative contamination.
Offer the patient sitz baths.	This will cleanse the perineum area, relieve pain and itching, and relieve the discomfort by relaxing the anal region, promoting healing.

4.Disturbed Body Image

Ostomy (ileostomy and colostomy) is a life-changing procedure that causes physical changes and can lead to psychological distress affecting individuals’ self-confidence and interpersonal relationships.

Nursing Diagnosis

• Disturbed body image

Related to

• Altered appearance changes in physical structure and function.
• Loss of bowel movement control.
• Major changes in lifestyle (clothing choices, exercise, diet, and bathroom habits).

Evidenced by

• Verbalized appearance concerns (change in body image).
• Verbalization of fear of rejection or other people’s reactions.
• Refusal to inspect, look at the stoma or participate in self-care.
• Negative self-concept.
• Isolation from others (social activities).

Desired Outcomes and Goals

• The patient will verbalize acceptance of the self and change in self-concept.
• The patient will be actively engaged in ostomy self-care.
• The patient will begin to deal with the current situation constructively.
• The patient will request information on living with a stoma.

Nursing Assessments and Rationales

The nursing assessments of a patient who has undergone ileostomy or colostomy with a disturbed body image include the following:

Nursing Assessment	Rationale
Note withdrawal behaviors, including non-involvement in care, increased dependency, and manipulation.	This suggests adjustment problems that require further assessment and therapy.
Assess significant other (SO) and family support.	Supportive family or spouse can be vital in helping the patient cope with the changes. Involving the patient’s support system in care planning and care intervention can help promote healing.
Note the patient’s age and lifestyle factors affecting care.	Navigating ostomy can be difficult at any age due to trauma and associated physical changes, especially in younger and more active patients.
Establish whether counseling and support were initiated when ostomy was first discussed.	Ostomy may require thorough therapy to ensure support. Support and counseling promote coping.

Nursing Interventions and Rationales

The nursing interventions of a patient who has undergone ileostomy or colostomy with a disturbed body image include the following:

Nursing Intervention	Rationale
Encourage the patient to verbalize their feelings about the ostomy. Acknowledge the feelings (anxiety, anger, depression, and grief)and their normality	This will help the patient accept the situation and realize these feelings are not abnormal or unusual. In this case, the patient should not feel guilty about these feelings and should recognize them for effective intervention.
Review with the patient the reason for the ostomy procedure and future expectations.	Patients are likely to accept and cope with changes due to ostomy if they realize the procedure aims to correct complications due to a long-term illness. This could reduce trauma and self-image problems since body function could return to “normal.”
Take a positive treatment/intervention approach.	Show confidence in ostomy care and avoid showing disgust or other facial expressions that could cause emotional harm to the patient’s ego.
Help the patient visualize a normal life by pointing out signs of healing, the normal appearance of the stoma, and assuring the patient that it might take some time to adjust.	Integration of the stoma into the patient’s body image could take time (months and years). Assuring the patient, they can still wear clothes, eat food they like, and participate in sports can help with coping.
Provides the patient and the SO with opportunities to observe and touch the stoma.	This can help promote acceptance and reassure the patient and the SO that the stoma is not as fragile as they might think.
Provide the patient with an opportunity to participate in self-care.	This can help promote independence in self-care and improve self-confidence resulting in acceptance.
Consider a support group for the patient.	Since adopting and accepting the new changes take time, joining a support group with other ostomy patients can empower and provide tips on approaching the transition.
Recommend therapy/counseling to the patient.	As the patient grieves the loss of body image, anger, anxiety, and depression could develop, requiring counseling to overcome challenges.

 

5.Risk for sexual dysfunction

Patients with a permanent ostomy have an increased risk of suffering sexual dysfunction. For instance, ileostomy and colostomy can distort body image, destabilize self-image, and adversely affect sexual functioning. Sexual relationships and intimacy are crucial aspects of life and should continue even after an ostomy.

Nursing Diagnosis

• Risk for sexual dysfunction.

Related to

• Altered physical body structure and function.
• Increased concern about the significant other’s response.
• Disrupted sexual response patterns such as erectile dysfunction.

Evidenced by

Note: A risk diagnosis does not have evidence of signs and symptoms since the problem is not there, and intervention focuses on intervention.

Desired Outcomes and Goals

• The client will verbalize an understanding of the relationship between the current physical condition and sexual problems/challenges.
• The patient will identify acceptable and alternative sexual behavior/practices.
• The client will report the resumption of a sexual relationship.

Nursing Assessments and Rationales

The nursing assessments of a patient who has undergone ileostomy or colostomy with a risk for sexual dysfunction include the following:

Nursing Assessment	Rationale
Establish the patient’s and spouse’s sexual relationship before the disease or surgery.	The disease process and the resulting mutilation and ostomy could significantly impact the patient’s control of body function affecting the patient’s sexuality.
Determine whether the patient and SO expect intimacy problems related to an ostomy.	There is the possible fear of rejection by the significant other and inability to reach the desired intimacy level. Identifying future desires and expectations can help develop an intervention plan to meet sexual needs over time.

Nursing Interventions and Rationales

The nursing assessments of a patient who has undergone ileostomy or colostomy with a risk for sexual dysfunction include the following:

Nursing Intervention	Rationale
Encourage the patient to raise concerns and ask questions. Provide information as needed.	This will move the patient towards accepting the limitations and prognosis.
Review the sexual functioning of the patient and significant other.	This will help understand whether the surgery has altered sexual functioning. This will help establish the need to explore alternative satisfaction methods.
Discuss with the patient and SO the likelihood of resuming sexual activity after discharge starting slowly and progressing.	Knowing what to expect in the future during the recovery period is crucial for the patient and the SO since it helps prevent performance anxiety. In addition, this will help find alternative stimulation and sexual satisfaction methods.
Encourage both partners to have a dialogue. Recommend using a cover for the pouch, underwear, or T-shirt to enhance sexual activity.	This could help reduce self-consciousness, feelings, and embarrassment during sexual contact.
Encourage the use of humor to address distracting factors.	This can help resolve problems. A sense of humor and laughter can help deal with challenging situations and enhance a positive sexual experience.
Encourage role play in possible interactions in the future, especially when the patient is dealing with new partners.	Rehearsing can help deal with real situations when new partners avail themselves.
Provide appropriate birth control information and emphasize impotence does not equate to being sterile.	Unwanted pregnancy could occur as the partners explore new ways to satisfy themselves sexually.
Schedule a visit to an ostomy nurse/doctor.	This can help the patient gather information on how others have resolved their sex-related problems.
Recommend and refer the patient to a sex therapist when necessary.	If the sexual dysfunction persists, a trained sexual therapist could help improve the sexual relationship between the patient and spouse.

6.Risk for Deficient fluid volume

This is where the fluid taken is less than the fluid lost in the body. Patients who have undergone ileostomy or colostomy are likely to be dehydrated due to various reasons such as excessive bleeding, inability to access sufficient fluid, and reduced intake of fluid, among other reasons

Nursing Diagnosis

• Risk for deficient fluid volume.

Related to (Risk factors)

• Excessive fluid loss through various routes. For example(diarrhea and preoperative emesis).
• Fluid intake restriction for medical reasons.
• Fluid loss through abnormal routes such as perineal wound drainage tubes and intestinal tubes.
• Impaired fluid absorption due to loss of effective colon function.
• Hypermetabolic factors include the healing process and inflammation.

Evidenced by

• Not Applicable: A risk diagnosis does not have evidence of signs and symptoms since the problem is not there, and intervention focuses on intervention.

Desired Outcomes and Goals

• The patient will remain hydrated, evidenced by optimal skin turgor, stable vitals, normal urinary output, and moist mucous membranes.
• The patient will verbalize measures to prevent and address fluid volume loss.
• The patient will demonstrate changes to prevent fluid volume loss.

Nursing Assessments and Rationales

Nursing Assessment	Rationale
Monitor fluid intake and output and keep note of liquid stool.	Since ileostomy is associated with fluid loss, monitoring I&O is crucial since it directly indicates fluid balance.
Weigh the patient regularly.	Fluid losses due to ileostomy range from 500 to 800mL per day. Weighing the patient can help identify changes in fluid volume.
Monitor and assess the patient’s vital signs	Check for tachycardia, skin turgor, mucus membrane, and capillary refill. In addition, reduced blood circulation could lead to hypotension and irregular/weak pulse.
Check and monitor lab results, including electrolytes and Hct.	This will help establish the patient’s fluid replacement needs by detecting fluid imbalance and homeostasis.
Evaluate the patient’s oral mucosa and skin turgor.	Skin turgor is one of the most effective methods to identify dehydration signs. Skin turgor leads to skin elasticity indicating dehydration. In addition, the examination could include furrows on the tongue, indicating dehydration.
Assess the patient’s urine color and amount.	The patient’s normal urine should be above 30ml/hr. In addition, concentrated urine indicates dehydration.

Nursing Interventions and Rationales

 

Nursing Intervention	Rationale
Reduce ice chips intake while under gastric intubation	Ice chips could lead to increased gastric secretions and electrolyte washout.
Administer electrolytes and IV fluid as indicated	This is crucial to maintain organ function and tissue perfusion.
Encourage the patient to take the indicated fluid amount.	Oral fluid replacement is less costly, making it crucial to remind the patient to take fluids as indicated to avoid fluid volume deficit.
Inform the patient of the importance of practicing oral hygiene.	Having a dry and stick mouth can be due to dehydration. This can be reduced by increasing fluid intake and practicing good oral hygiene.

7.Risk for imbalanced nutrition

Ostomy could increase the patient’s risk of nutritional imbalance. The nutrients we intake should be adequate to meet the body’s metabolic needs. However, patients who undergo ostomy may have altered GI function resulting in a nutritional imbalance (less than the body’s requirement).

Nursing Diagnosis

• Imbalanced nutrition (less than body requirements).

Related to

• Altered food intake preoperatively and prolonged anorexia.
• Altered food absorption
• Diarrhea
• Depression
• Restriction of bulk foods due to medical reasons.

Evidenced by

• Not Applicable: A risk diagnosis does not have evidence of signs and symptoms since the problem is not there, and intervention focuses on intervention.

Desired Outcomes and Goals

• The patient will maintain the required/desired body weight.
• The patient will have normal lab values and be free from malnutrition.
• The patient will have a diet plan to help meet nutritional needs.
• The patient will have limited GI disturbances.
• The patient will verbalize proper nutritional management at home.

Nursing Assessments and Rationales

Nursing Assessment	Rationale
Conduct a nutrition screening	This will help understand the patient’s current nutritional status and nutritional needs. This will also inform nutritional interventions.
Assess the patient’s lab values	Lab values such as albumin and prealbumin could indicate a nutritional imbalance.
Establish the patient’s mobility and ability to complete daily activities.	The inability to complete regular activities could be due to a lack of appropriate nutrition.
Assess the patient’s need for feeding assistance devices.	Patient weakness following ostomy could affect motor function. In this case, using specialized eating utensils can help the patients feed appropriately.
Auscultate the patient to identify bowel sounds.	Normal bowel sounds indicate the return of intestinal function hence the patient is ready to resume oral food intake.
Instruct the patient to resume solid food intake gradually.	This will help the patient reduce nausea and abdominal cramps.

Nursing Interventions and Rationales

Nursing Intervention	Rationale
Educate the patient on the body’s nutritional needs.	This will allow the patient to gain knowledge on how to take care of self after discharge.
Recommend increased use of acidophilus, buttermilk, and yogurt.	This will help reduce gas and odor formation.
Identify foods that cause gas and odor and avoid them. Then reintroduce each of the foods gradually.	Ostomy is associated with increased sensitivity to some foods. Experimenting with different foods can help establish whether they are problematic.
Suggest to the patient the limiting of foods high in cellulose and other foods/fruits such as stewed apricots, prunes, grapes, strawberries, and dates.	These foods cause an increase in ileal effluent. In addition, foods high in cellulose require colon bacteria for digestion which is not present following colostomy.
Provide supplements as indicated.	The nurse should ensure the patient continues taking nutritional supplements to maintain body strength.
Discussing with the patient the impact of swallowed air is important.	Anxiety, gulping down food, snoring, and drinking with a straw could cause increased flatus production. This increases the need for emptying, leading to leakage due to increased pressure in the pouch.
Avail resources about nutrition to the patient.	These resources will be used following discharge to help the patient remain independent in their care.
Encourage the patient to maintain good oral hygiene.	Promoting oral hygiene can help increase the patient’s appetite by addressing the nutritional imbalance. In addition, good oral hygiene will help maintain moist oral mucosa, further aiding in food digestion.
Administer antiemetics as indicated.	Patients with an underlying condition that cause nausea may require antiemetics to maintain appetite, prevent nausea and increase food intake tolerance.

8.Risk for constipation and diarrhea

Nursing Diagnosis

• Risk for diarrhea and constipation.

Related to

• Reduced fluid or diet intake.
• Ostomy placement in the sigmoid or descending colon.

Evidenced by

• Not Applicable: A risk diagnosis does not have evidence of signs and symptoms since the problem is not there, and intervention focuses on intervention.

Desired Outcomes and Goals

• The patient will create an elimination pattern that suits physical needs.
• The patient will adopt a lifestyle with the desired consistency and amount of effluent.

Nursing Assessments and Rationales

Nursing Assessment	Rationale
Establish the patient’s bowel lifestyle and habits prior to the ostomy.	This will help develop an effective and timely schedule for irrigating and pouch change for the patient.
Investigate delayed or absence of effluent and auscultate the patient for bowel sounds.	Adynamic ileus following operation lasts 2 to 3 days, while draining after ileostomy should start in 12 to 14 hours. Continued adynamic ileus could indicate stomal or ileus obstruction resulting from edema, tightly fit pouch, stoma stenosis, or prolapse.

Nursing Interventions and Rationales

Nursing Intervention	Rationale
Inform the patient that the effluent will be liquid first after ileostomy. However, emphasize the need for the patient to report any case of constipation to the physician or enterostomal nurse.	The ileum eventually starts its water absorption role allowing the formation of a pasty/semi-solid discharge. However, constipation could indicate obstruction, while lack of stool could be an emergency requiring immediate medical attention.
Review the dietary amount, pattern, and fluid intake pattern with the patient.	Inadequate intake of roughage, fiber, and fluids could affect stool consistency. In this case, planning proper fluid intake, roughage, and fiber could help determine the desired stool consistency.
Review the colon’s physiology and establish the proper management of sigmoid ostomy with the patient.	Knowledge of colon physiology and sigmoid ostomy management will be key to helping the patient understand individual care needs.
Demonstrate to the patient how to properly use the irrigation equipment. This should be based on the institution’s policy and with the guidance of a certified ostomy, wound, and continence nurse or physician.	Wound irrigation could be done daily or as instructed by the physician. Cleaning the bowel regularly is crucial.
Involve the patient in the regular care of the ostomy.	Encouraging the patient’s independence and control of the ostomy management could facilitate rehabilitation.
Instruct the patient to use the TENS unit as indicated.	Transcutaneous Electrical Nerve Stimulation (TENS) unit is used to pass electrical impulses on the skin. This unit is used in some patients to relieve postoperative ileus and stimulate peristalsis.

9.Disturbed sleep pattern

Sleep and individual well-being go hand in hand. In this case, good sleep is key to maintaining overall health. The body needs sleep to reenergize for effective mental and physical functioning. Insomnia is common in individuals with disturbed sleep patterns because they can’t get enough sleep. This may be in response to stressors, pain, depression, and other medical factors. In this case, the nurse must be aware of sleep disturbances and how to help the patient achieve good sleep to enhance their overall health and well-being.

Nursing Diagnosis

• Disturbed Sleep Pattern.

Related to

• Internal factors such as fear of pouch leakage, stoma injury, and psychological stress.
• External factors such as excessive ostomy effluent and flatus and the need for ostomy care.

Evidenced by

• Change in behavior, such as lethargy and irritability.
• The patient verbalizes sleep interruption, general tiredness, and decreased health status.
• The patient verbalizes difficulty falling asleep
• Decreased quality of life.
• Lack of energy
• Concentration and memory problems
• Daytime sleepiness.

Desired Outcomes and Goals

• The patient will report a feeling of comfort, rest, and improved well-being.
• The patient will rest and sleep between disturbances.

Nursing Assessments and Rationales

Nursing assessment is crucial in assisting the nurse in identifying changes that could lead to disturbed sleep patterns. This will help stop the problem from becoming chronic.

Nursing Assessment	Rationale
Investigate the patient’s past sleeping pattern in a normal environment. This includes the length and depth of sleep, among other factors.	Everyone has varying sleeping patterns. Having adequate information about the patient’s sleeping pattern will provide baseline data to evaluate the patient and improve sleep.
Observe the patient’s sleep and wake behaviors. Note the length (number of hours) the patient is asleep.	This will provide baseline data for evaluating insomnia.
Note the psychological and physical factors that hinder sleep in the patient. Psychological factors could include pain, anxiety, and fear, while physical factors could include pain, discomfort, noise, urinary frequency, and the nurse’s need to monitor intestinal function.	Understanding these will provide an objective picture of factors hindering adequate sleep.
Establish whether the patient understands the causes of sleeping problems.	The patient’s subjective report of sleeping disturbance causes could differ from the objective factors.
Assess whether the patient is using medication that could affect sleep.	Some medications could affect the pattern and quality of sleep. In addition, following schedules that require accuracy could also affect the patient’s sleeping pattern.

Nursing Interventions and Rationales

Nursing Intervention	Rationale
Explain to the patient the need to frequently monitor the function of the intestines early in the postoperative period.	This will ensure the patient is more tolerant of staff disturbances as they check progress in recovery. The patient will also understand the importance of care.
Provide the required pouching system to the patient. Suggest to the patient regularly empty the pouch before retiring to bed.	Emptying the pouch regularly could reduce leakage threats and disturbances during sleep.
Inform the patient that the stoma is not as fragile and will not be injured during sleep.	This is reassuring to the patient and will help him/her sleep better if the stoma is secure/safe.
Restrict caffeine intake.	Fluids and foods containing caffeine could delay falling asleep and interfere with REM sleeping stage. This could affect proper rest.
Educate the patient on proper food and fluid intake. Limit the intake of heavy meals, the use of alcohol, and smoking before bedtime.	Heavy meals before bedtime could lead to gastrointestinal upset, hindering sleep onset. In addition,  alcohol could lead to drowsiness, supporting sleep onset while interfering with the REM sleep stage. Reducing fluid intake will help reduce the amount of effluent hence the patient will require limited pouch changes.
Support the patient in maintaining the usual rituals for bedtime.	Maintaining bedtime rituals can help the patient get ready for sleep and promote relaxation. A consistent sleeping schedule regulates circadian rhythm, resulting in decreased energy required to adapt to changes.
Instruct the patient to write a journal on various problems experienced before retiring.	This will help identify mental activities just before going to sleep.
Discuss the right environment for getting rest and sleep.	A cool, dark, and quiet environment is conducive for sleep.
Inhibit daytime naps unless necessary.	Napping during the day could disrupt sleep during the night.
Investigate with the patient the cause of excessive effluent and flatus. Confirm with a dietitian the need to restrict certain foods if the problem is diet related.	Identifying the cause can help take the appropriate corrective measures to promote rest and sleep.
Administer sedatives or analgesics during bedtime as instructed.	Pain could interfere with the patient’s sleep. Providing timely medication can help achieve sleep and rest, especially in the initial postoperative period.

10.Deficient knowledge

Knowledge deficiency refers to the lack of psychomotor ability and cognitive information needed for health restoration and preservation. Having knowledge plays a crucial role in promoting patient recovery. In this case, the nurse is responsible for establishing the patient’s knowledge gaps and needs and teaching the patient matters of concern to their health. Educating the patient following ileostomy and colostomy is crucial since it allows patients to understand how to effectively manage their care to achieve self-care.

Nursing Diagnosis

• Deficient Knowledge

Related to

• Lack of familiarity with ileostomy or colostomy.
• Lack of interest in care involvement.
• Lack of recall of information and misconception.
• Cognitive limitation

Evidenced by

• The patient verbalizes inaccurate statements about ostomy.
• Inability to recall and accurately demonstrate ostomy care.
• The development of a complication related to insufficient or lack of knowledge.
• Questions about ostomy care.

Desired Outcomes and Goals

• The patient will verbalize a proper understanding of ostomy (ileostomy and colostomy), including the disease process, complications, and prognosis.
• The patient will demonstrate the ability to irrigate the ostomy.
• The patient will demonstrate the ability to remove, clean, and insert the pouch.
• The patient will recognize complications signs early and seek immediate help.
• The patient will initiate lifestyle changes demonstrating proper management of ostomy.

Nursing Assessments and Rationales

The nursing assessments of a patient who has undergone ileostomy or colostomy with risk for sexual dysfunction. Include the following:

Nursing Intervention	Rationale
Investigate the patient’s ability to learn and perform the desired care.	Recognizing cognitive abilities and impairments is crucial to help develop the appropriate teaching plan.
Assess the patient’s desire, motivation, and learning willingness.	Since a lot of energy is required to learn, the patient must be motivated to learn and be able to see the need and purpose for learning.
Establish the priority learning needs for the patient based on the care and management plan.	When the patient has a background of the situation, it is crucial to understand what to prioritize to ensure valuable time is not wasted on unnecessary information.
Assess family or SO assistance.	The patient could require family/SO’s support in performing self-care, especially if the patient is too young, older, disabled, or unable to follow instructions.

Nursing Interventions and Rationales

The nursing assessments of a patient who has undergone ileostomy or colostomy with risk for sexual dysfunction. Include the following:

Nursing Intervention	Rationale
Encourage patient confidence.	A lack of confidence in performing ostomy care could hinder participation in care. Providing positive feedback and involving the patient in care could help boost confidence.
Include the patient when developing the teaching plan and learning objectives and goals.	This will allow the patient to understand what to expect during education sessions and enhance compliance with recommended care.
Review the physiology and implications of the surgical intervention and discuss anticipated changes with the patient.	This will provide the knowledge base to help the patient make informed decisions. This will also provide an opportunity for the patient to clarify existing misconceptions about the situation.
Include pictures, written text, and video learning resources.	This will provide reference sources allowing the patient to obtain additional information post-operation and after discharge to support self-care.
Instruct the patient and SO on ostomy care.	This will enhance the patient’s knowledge and promote positive management reducing the risk of improper care and associated complications.
Recommend an increase in fluid intake, especially during warm weather.	The loss of normal water and electrolyte conservation ability by the colon could lead to dehydration and constipation. Drinking more fluids during warm weather is crucial in maintaining fluid volume.
Suggest and discuss with the patient limited salt intake.	Since salt could lead to increased ileal output, recommending reduced salt intake can help reduce the risk of dehydration and reduce the frequency of ostomy care and associated inconveniences.
Discuss with the patient the need for periodic evaluation of nutritional needs and supplementation of minerals and vitamins as needed.	Lack of proper vitamins and mineral absorption could lead to nutritional deficiencies.
Emphasize the need to properly chew food and take fluids after meals while moderating intake of high-fiber foods and avoiding cellulose foods.	This will reduce the risk of bowel obstruction in ileostomy and colostomy patients.
Review foods that could increase flatus with the patient, such as cabbage, fish, onions, beer, beans, carbonated drinks, and highly seasoned foods.	This aims to promote better ostomy control by regulating the necessity to empty the pouch.
Educate and counsel the patient about medication use and problems related to disturbed bowel function. Refer the patient to the pharmacist for more advice as needed.	An altered intestinal function could affect oral drug disintegration and absorption leading to more pronounced side/adverse effects. In this case, it is crucial to inform the patient what to expect in terms of response to these medications and when to seek medical attention.
Discuss with the patient the resumption of normal function or pre-surgery activity level	Planning will help the patient return their activity level to the same level or degree as pre-surgery.
Allow the patient to demonstrate care and provide demonstrations and positive feedback for efforts made	This is the best approach to ensuring that teaching is effective. Observing the patient perform all care activities, including emptying the pouch, cleaning, irrigating, and changing the ostomy system, is the best way to promote learning.