Nursing Care Plans for Colostomy – Best Nursing Care Plans (2022)

This article discusses Nursing Care Plans for Colostomy plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

A colostomy is a surgical surgery that involves the removal of one end of the large intestine through the abdominal wall. One end of the colon is diverted via an incision in the abdominal wall to establish a stoma. A stoma is a skin opening to which a feces-collecting pouch is attached. Whether temporary or permanent, people who have colostomies have pouches on their sides where feces gather and may be conveniently disposed of.

Colostomies aren’t often permanent, especially in children who have been born with congenital abnormalities.

A colostomy can result from one of several procedures to correct problems with the lower digestive tract. Ileostomy and urostomy are two other types of “ostomies.” An ileostomy is a diversion of the small intestine’s bottom. A urostomy is a diversion of the tubes that carry urine out of the bladder.

Colostomy

This procedure is usually performed for lesions in the large intestine caused by cancer, diverticulitis, or obstruction of the large intestine in an area close to the rectum.

Reasons for Colostomy

The colostomy is done in the following situations:

A blockage of the intestines may be due to a tumor or congenital disorder.

Injury of the intestine that does not heal (intestinal ulcer) after blood supply is restored.

A severe infection leads to gangrene or the death of some part of the intestine.

Sigmoid colon cancer requires the removal of a large portion of the colon and rectum.

Surgery to control anus bleeding resulting from fistula in inflammatory bowel disease.

Surgical procedures are done around the anus, resulting in injury or damage to the colon.

Conditions that require removal of rectum and anus such as ulcerative colitis, proctitis, and colon cancer

Risks of Colostomy

Organ damage is among the other risks of colostomy. Injury can affect the small intestines, colon, anus, and rectum, which result in incontinence or constant leakage of stool out from a new opening around the anus. The stool may have a foul odor that causes embarrassment to the patient.

Breaking open of wounds around the anus, requiring re-surgery to close the opening.

A hernia may occur at the opening of the colon, causing the anus to touch the ground nearly.

Constipation.

Gas in the colon or rectum causes diarrhea.

Risk of impaired skin integrity, e.g., pressure ulcer.

Infections around the wound either from fecal matter or blood.

Internal bleeding from the damaged intestine during surgery.

Pain around the anus or abdomen after the operation may be treated by administering pain-relieving drugs.

Tear at the stoma site due to local inflammation, impingement on the wound by stool, incomplete skin closure, and external pressure from a bag/stool.

Infections because of contamination of the stoma tract with stool, increased secretion in the wound at the stoma site, and opening from the intestine to the skin surface.

Types of colostomy

Temporary colostomy: A temporary colostomy is performed to divert the fecal stream from the distal colon, which may be obstructed by tumor inflammation, or requires being “put-to-test” because of anastomosis or a pouch procedure. A temporary colostomy may be created in the transverse colon or sigmoid colon.

Permanent colostomy: A permanent colostomy is performed to treat malignancies of the colon. Other indications may include irrevocable rectal strictures, incontinence of bowel, or inflammatory bowel disease. A permanent colostomy can be fashioned similar to a temporary colostomy but is often an end.

Position

Supine, with arms extended on arm boards.

Incision Site

Dependent on the segment of the colon to be used.

Packs/ Drapes

Laparotomy pack colostomy

Four folded towels

Transverse Lap sheet

Minor pack

Instrumentation

Major Lap tray

Intestinal tray

Closing tray

Internal surgical staples

Supplies/ Equipments

Basin set

Blades

Needle counter

Penrose drain

Internal stapling instruments

Glass rod and tubing with a colostomy pouch

Solutions – saline, water

Sutures

Medications

Dressings

Procedure

The abdomen is opened in the usual manner, and the segment of the colon is mobilized.

The colon can be brought out through the main incision or through an adjacent site from which a disk of skin and subcutaneous tissue has been excised.

The underlying rectus fascia muscle and peritoneal layers are incised to accommodate the colon. The appropriate segment is excised between two atraumatic (intestinal) clamps or the internal stapling instrument used to prepare and create the stoma.

A rod or bridge may be placed under the colon to avoid retraction in a loop colostomy.

The abdomen is rinsed with warm saline and routinely closed layers.

A colostomy pouch is applied over the stoma.

Methods of performing Colostomy

Loop Colostomy

When the colostomy is only temporary, this method is frequently used. This is due to the procedure’s ease of reversibility.

A hole in the abdominal wall above the pelvic bone is created on one or both sides. The intestine is fed through this incision, and a bag is attached to collect feces, which is usually flushed down the toilet.

Thorough colostomy (also called end stoma)

This entails creating a hole near the belly button in the skin covering your abdomen. A surgeon will then construct a stoma or aperture by bringing a loop of intestine out through the hole. An ostomy is a name for the opening. Your healthcare professional might refer to this as a stoma ileostomy if no section of your colon was removed.

Surgical staples are used to suture a loop colostomy in place. Surgical tape or an ostomy pouch, a tiny adhesive bandage, keeps the colostomy in place.

Colostomies are divided into two categories: side and end. Both cause the same problems for the patient, but they can be treated at home using unique dressing materials.

The treatment of a colostomy is a delicate procedure that necessitates a great deal of patience on the part of the patient.

Dressing sheets, adhesive strips, and elastic bandages are frequently required to keep excrement away from the skin. At the same time, the opening heals and does not become infected with hazardous bacteria that can generate an odor.

A stoma is an opening in the abdomen through which feces enter into a bag attached to the abdominal wall, and ostomates are people who have one.

After surgery, the protruding part of your intestine or colon that exits out from your body is called a stoma. The stoma may turn pink or scarlet over time, and a rigid ring of flesh called granulation tissue will form around it. An ostomy is a small opening under your skin used to remove stool from your body.

After surgery, your bowel movements are frequently loose and watery. Mucus, usually brown or clear in color, will be passed.

A colostomy bag is a device that collects feces from a stoma. It’s a waterproof bag worn outside your body that contains a little filter to catch any solid debris so you don’t feel it and can go about your business as usual.

A colostomy bag is usually put on the patient’s body so that an ostomate can move around freely without worrying about the pouch’s positioning or leakage.

Colostomy surgery is a lengthy and complicated procedure. It involves a team of surgeons and can take anywhere from 6 to 8 hours to complete, depending on how much intestine needs to be removed. For a patient, the long duration is inconvenient.

Procedure for Colostomy

Several procedures may be done depending on the type of colostomy.

Procedure for a temporary colostomy

This procedure is done to divert stool away from damaged bowel due to surgery. The surgeon will create a stoma at the colon level, remove a section of the healthy bowel and seal the remaining open ends. The length of a temporary colostomy depends on the size of the remaining bowel. The stoma will be closed from about 4-12 inches below the exit site. The goal is to avoid stool impaction at the opening from the intestine to the skin surface and promote the wound’s healing.

Deciding how long you need a temporary stoma should be based on your lifestyle, strength, and available support from family or friends. If you have strong supportive people around you who can help with the care of your bowel incontinence after surgery, you may not need a long-term colostomy.

Potential complications for temporary colostomy are infection at the open wound site, skin breakdown, and accumulation of stool at the opening from the intestine to the skin surface.

Procedure for a permanent colostomy

This procedure is done when the damaged bowel cannot be restored after surgery, as in the case of colon cancer. In this procedure, the surgeon will create a stoma at the level of the damaged section of the colon and rectum and then staple or suture the remaining ends together. The stoma will be sealed from about 4-12 inches below the exit site. The goal is to divert stool away from the damaged area and prevent the accumulation of stool at the opening from the intestine to the skin surface.

Potential complications for permanent colostomy are infection at the site of an open wound, skin breakdown, stomal stenosis (stoma narrows and cannot pass stool), and fecal accumulation at the opening from the intestine to the skin surface.

Bowel Technique

This is a specific technique of undertaking a colostomy. The aim is to prevent fecal matter from leaking out of the stoma. This technique helps reduce pain, swelling, and other complications after surgery.

Bowel technique procedure has a low risk of complications.

Steps for bowel technique

The patient should lie on his left side with knees bent, and hips flexed towards the chest, right arm overhead in a semi-flexed position.

The nurse will hold the stoma and ask the patient to relax while wrapping a thick gauze bandage around the waist.

The patient should remain in this position for 20 minutes.

The next step will be to perform a bowel evacuation, irrigation of stoma with saline solution or hydrogen peroxide solution (3%).

The next thing to do will be to clean the entire skin area with soap and water. This procedure must be repeated every 6 hours for the first two days following surgery.

The nurse will then have to apply a layer of gauze on the stoma and cover it with adhesive tape or skin prep solution. Band-Aids are not recommended as they stick to wound tissue and may cause pain, bleeding, infections, and skin breakdown at the site of bandage attachment.

Two days after surgery, the nurse will remove adhesive tape and gauze bandage and attach a wafer dressing or stoma guard. This is to prevent pressure sores from forming around the stoma.

On day three following surgery, the nurse will remove the wafer dressing or stoma guard, apply a layer of gauze on the stoma, and cover it with an adhesive bandage.

Every day after surgery, the nurse will clean the entire skin area with a mild soap solution. A permanent wafer dressing or stoma guard will be applied to the stoma about ten days following surgery.

The frequency of bowel eliminations after surgery is to follow the doctor’s orders, usually every 2-3 days until healing occurs. This will be reduced to 2 times weekly for some time.

Stomal expansion may also occur. This means that a small thin skin layer around the stoma gradually turns into a thick fold of skin. This will cause the stoma to enlarge and may cause difficulty when passing stool through that stoma opening.

Stomal enlargement is common in people who have had a colostomy for more than three months. In this case, applying an elastic ring at the base of the stoma helps keep it snugly in place. The flexible ring is applied to the stoma by a nurse and must be worn for at least two weeks continuously, followed by another two weeks with breaks of one day.

Perioperative Nursing Considerations

The colostomy pouch may or may not be applied in surgery.

A Vaseline gauze may encircle the stoma with a “fluff” type dressing applied.

If the institution has an “Ostomy Nurse,” the application of the colostomy pouch may be delayed until the clinical specialist can work with the patient and family.

Nursing Diagnosis for Colostomy

Specific nursing diagnoses for colostomy exist depending on the type of operation, the stage of recovery, and other factors that may affect the patient’s health.

Nursing diagnoses include the following:

Potential Nutritional Alteration: This diagnosis relates to a reduction in nutritional intake or absorption due to lifestyle changes, physical constraints, or pain following surgery.

Educating Patients: This nursing diagnosis describes a lack of knowledge or ability to care for a wound and avoid consequences.

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Reduced fluid intake, stool changes that cause dehydration, or fecal impaction near the stoma are all symptoms of potential fluid volume change.

Abdominal distension due to gas accumulation around the stoma

Anxiety stemming from the surgery, a pre-existing condition, and life changes, as well as a shift in role.

Infection at the surgical site might harm the patient’s overall health.

Skin Integrity: There’s a chance it’ll be harmed. Due to the presence of feces surrounding the stoma or at the opening from the gut, this diagnosis relates to the possibility of skin breakdown and other skin-related issues after surgery.

Injury Potential: The danger of harm from fecal impaction around the stoma or at the entry from the intestine to the skin surface is described in this nursing diagnostic.

Dyspnea as a result of surgery-related pain and fatigue-related weakness.

Chronic pain may impact the patient’s overall health as a result of the operation’s harm to the colon, rectum, and anus.

Constipation: This diagnosis refers to decreased bowel movements caused by inadequate fiber intake, inadequate water intake, and stool impaction around the stoma

Infection Risk: This diagnosis relates to a wound infection caused by feces entering the wound or moisture accumulating at the passage from the intestine to the skin surface.

Nursing Care Plans for Colostomy Based on Diagnosis

Nursing Diagnosis: Fluid Volume and Risk for deficient.

Risk factors may include:

Excessive losses through regular routes, e.g., preoperative emesis and diarrhea; high-volume ileostomy output.

Losses through abnormal routes, e.g., NG/intestinal tube, perineal wound drainage tubes.

Medically restricted intake.

Altered absorption of fluid, e.g., loss of colon function.

Hypermetabolic states, e.g., inflammation, healing process.

Desired Outcomes

Maintain adequate hydration as evidenced by moist mucous membranes, good skin turgor, and capillary refill, stable vital signs, and individually appropriate urinary output.

Nursing Interventions

Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly.

Rationale: Provides direct indicators of fluid balance. Most significant fluid losses occur with ileostomy, but they generally do not exceed 500–800 mL/day.

Monitor vital signs, noting postural hypotension, tachycardia. Evaluate skin turgor, capillary refill, and mucous membranes.

Rationale: Reflects hydration status and the possible need for increased fluid replacement.

Limit intake of ice chips during the period of gastric intubation.

Rationale: Ice chips can stimulate gastric secretions and wash out electrolytes.

Monitor laboratory results, e.g., Hct and electrolytes

Rationale: Detects homeostasis or imbalance and aids in determining replacement needs

Administer IV fluid and electrolytes as indicated.

Rationale: It may be necessary to maintain adequate tissue perfusion/organ function.

Nursing Diagnosis: Skin/Tissue Integrity, impaired

May be related to:

Invasion of body structure (e.g., perineal resection).

Stasis of secretions/drainage.

Altered circulation, edema, malnutrition.

Possibly evidenced by:

Disruption of skin/tissue: the presence of incision and sutures, drains.

Desired Outcomes

Achieve timely wound healing free of signs of infection.

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Nursing Interventions

Observe wounds, note characteristics of drainage.

Rationale: Postoperative bleeding is most likely to occur during the first 48 hr, whereas infection may develop at any time. Depending on the type of wound closure (e.g., first or second intention), complete healing may take 6-8 mo.

Change dressings as needed using the aseptic technique

Rationale: Large amounts of serous drainage require that dressings be changed frequently to reduce skin irritation and potential for infection.

Encourage a side-lying position with the head elevated. Avoid prolonged sitting.

Rationale: Promotes drainage from perineal wounds/drains, reducing pooling risk. Prolonged sitting increases perineal pressure, reduces circulation to the wound, and may delay healing.

Irrigate wound as indicated, using normal saline (NS), diluted hydrogen peroxide, or antibiotic solution.

Rationale: May be required to treat preoperative inflammation and infection or intraoperative contamination.

Provide sitz baths.

Rationale: Promotes cleanliness and facilitates healing, especially after removing packing (usually day 3–5).

Nursing Diagnosis: Acute Pain

May be related to:

Physical factors: e.g., disruption of skin/tissues (incisions/drains).

Biological: activity of disease process (cancer, trauma).

Psychological factors: e.g., fear, anxiety.

Possibly evidenced by:

Reports of pain, self-focusing.

Guarding/distraction behaviors, restlessness.

Autonomic responses, e.g., changes in vital signs.

Desired Outcomes

Verbalize that pain is relieved/controlled.

Display relief of pain, able to sleep/rest appropriately

Demonstrate relaxation skills and general comfort measures as indicated for the individual situation.

Nursing Interventions

Assess pain, noting location, characteristics, intensity (0–10 scale).

Rationale: Helps evaluate the degree of discomfort and effectiveness of analgesia or may reveal developing complications. Because abdominal pain usually subsides gradually by the third or fourth postoperative day, continued or increasing pain may reflect delayed healing or peristomal skin irritation. Note: Pain in the anal area associated with abdominal-perineal resection may persist for months.

Encourage the patient to verbalize concerns. Active-listen these concerns and provide support by acceptance, remaining with the patient, and giving the appropriate information.

Rationale: Reduction of anxiety/fear can promote relaxation or comfort.

Provide comfort measures, e.g., mouth care, back rub, repositioning (use proper support measures as needed). Assure patient that position change will not injure stoma.

Rationale: Prevents drying of oral mucosa and associated discomfort. Reduces muscle tension, promotes relaxation, and may enhance coping abilities.

Encourage the use of relaxation techniques, e.g., guided imagery, visualization. Provide diversional activities.

Rationale: Helps patient rest more effectively and refocuses attention, thereby reducing pain and discomfort.

Assist with ROM exercises and encourage early ambulation. Avoid prolonged sitting position.

Rationale: Reduces muscle/joint stiffness. Ambulation returns organs to normal position and promotes the return of the usual level of functioning. Note: The presence of edema, packing, and drains (if perineal resection has been done) increases discomfort and creates a sense of needing to defecate. Ambulation and frequent position changes reduce perineal pressure.

Investigate and report abdominal muscle rigidity, involuntary guarding, and rebound tenderness.

Rationale: Suggestive of peritoneal inflammation, which requires prompt medical intervention.

Administer medication as indicated, e.g., narcotics, analgesics, patient-controlled analgesia (PCA).

Rationale: Relieves pain, enhances comfort, and promotes rest. PCA may be more beneficial, especially following anal-perineal repair.

Provide sitz baths.

Rationale: Relieves local discomfort, reduces edema, and promotes healing of the perineal wound.

Apply/monitor effects of transcutaneous electrical nerve stimulator (TENS) unit.

Rationale: Cutaneous stimulation may be used to block transmission of the pain stimulus.

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Nursing Diagnosis: Body Image, disturbed

May be related to

Biophysical: the presence of stoma; loss of control of bowel elimination.

Psychosocial: altered body structure.

The disease process and associated treatment regimen, e.g., cancer, colitis.

Possibly evidenced by:

Verbalization of change in body image, fear of rejection/reaction of others, and negative feelings about body.

The actual change in structure and function (ostomy)

Not touching/looking at stoma, refusal to participate in care

Desired Outcomes

Verbalize acceptance of self in a situation, incorporating change into self-concept without negating self-esteem.

Demonstrate beginning acceptance by viewing/touching stoma and participating in self-care.

Verbalize feelings about stoma/illness; begin to deal constructively with the situation.

Nursing Interventions

Ascertain whether support and counseling were initiated when the possibility and necessity of ostomy were first discussed.

Rationale: Provides information about patient’s/SO’s level of knowledge and anxiety about an individual situation.

Encourage patient/SO to verbalize feelings regarding the ostomy. Acknowledge the normality of feelings of anger, depression, and grief over loss. Discuss daily “ups and downs” that can occur.

Rationale: Helps patient realize that feelings are not unusual and that feeling guilty about them is not necessary or helpful. The patient needs to recognize feelings before they can be dealt with effectively.

Review reason for surgery and future expectations.

Rationale: Patients may find it easier to accept or deal with an ostomy done to correct chronic or long-term disease than for traumatic injury, even if ostomy is only temporary. Also, patients who will be undergoing a second procedure (to convert ostomy to a continent or anal reservoir) may encounter less severe self-image problems because body function eventually will be “more normal.”

Note withdrawal behaviors increased dependency, manipulation, or non-involvement in care.

Rationale: Suggestive of problems in adjustment that may require further evaluation and more extensive therapy.

Provide opportunities for patient/SO to view and touch stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind the patient that it will take time to adjust, both physically and emotionally.

Rationale: Although integration of stoma into body image can take months or even years, looking at the stoma and hearing comments (made in a standard, matter-of-fact manner) can help the patient with this acceptance. Touching stoma reassures patient/SO that it is not fragile and that slight movements of stoma actually reflect normal peristalsis.

Provide an opportunity for the patient to deal with ostomy through participation in self-care.

Rationale: Independence in self-care helps improve self-confidence and acceptance of the situation.

Plan/schedule care activities with the patient.

Rationale: Promotes a sense of control and conveys that the patient can handle the situation, enhancing self-concept.

Maintain a positive approach during care activities, avoiding expressions of disdain or dislike. Do not take angry expressions of the patient and SO personally.

Rationale: Assists patient and SO to accept body changes and feel all right about self. Anger is most often directed at the situation, and the individual lacks control over what has happened (powerlessness), not with the individual caregiver.

Ascertain patient’s desire to visit with a person with an ostomy. Make arrangements for a visit, if desired.

Rationale: A person who is living with an ostomy can be a good support system/role model. It helps reinforce teaching (shared experiences) and facilitates acceptance of change as the patient realizes “life does go on” and can be relatively ordinary.

Nursing Diagnosis: Skin Integrity, the risk for impaired

Risk factors may include:

Absence of sphincter at stoma

Character/flow of effluent and flatus from the stoma

Reaction to product/chemicals; improper fitting/care of appliance/skin.

Desired Outcomes

Maintain skin integrity around the stoma.

Identify individual risk factors.

Demonstrate behaviors/techniques to promote healing/prevent skin breakdown.

Nursing Interventions

Inspect stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color), rashes.

Rationale: Monitors healing process and effectiveness of appliances and identifies areas of concern, need for further evaluation, and intervention. Early identification of stomal necrosis, ischemia, or fungal infection (from changes in normal bowel flora) provides timely interventions to prevent serious complications. The stoma should be red and moist. Ulcerated areas on the stoma may be from a pouch opening that is too small or a faceplate that cuts into the stoma. In patients with an ileostomy, the effluent is rich in enzymes, increasing the likelihood of skin irritation. Inpatient with a colostomy, skincare is not as great a concern because the enzymes are no longer present in the effluent.

Clean with warm water and pat dry. Use soap only if the area is covered with a sticky stool. If the paste has collected on the skin, let it dry, then peel it off.

Rationale: Maintaining a clean and dry area helps prevent skin breakdown.

Measure stoma periodically: at least weekly for the first 6 weeks, then once a month for 6 mo. Measure both the width and length of the stoma.

Rationale: As postoperative edema resolves (during the first 6 weeks), the stoma shrinks and the size of the appliance must be altered to ensure proper fit so that effluent is collected as it flows from the ostomy and contact with the skin is prevented.

Verify that opening on adhesive backing of the pouch is at least 1⁄16 to 1⁄8 in (2–3 mm) larger than the base of the stoma, with adequate adhesiveness left to apply pouch.

Rationale: Prevents trauma to the stoma tissue and protects the peristomal skin. Adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis.

Use a transparent, odor-proof drainable pouch.

Rationale: A transparent appliance during the first 4–6 weeks allows easy observation of stoma without the necessity of removing pouch/irritating skin.

Apply appropriate skin barrier: hydrocolloid wafer, karaya gun, extended-wear skin barrier, or similar products.

Rationale: Protects skin from pouch adhesive, enhances adhesiveness of pouch, and facilitates removal of the pouch when necessary. Note: Sigmoid colostomy may not require the use of a skin barrier once stool becomes formed and elimination is regulated through irrigation.

Empty, rinse, and cleanse ostomy pouch regularly, using appropriate equipment.

Rationale: Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution removes bacteria and odor-causing stool and flatus and deodorizes the pouch.

Support surrounding skin when gently removing the appliance. Apply adhesive removers as indicated, then wash thoroughly.

Rationale: Prevents tissue irritation or destruction associated with “pulling” pouch off.

Investigate reports of burning, itching, or blistering around the stoma.

Rationale: Indicative of effluent leakage with peristomal irritation, or possibly Candida infection, requiring intervention.

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Evaluate adhesive product and appliance fit on an ongoing basis.

Rationale: Provides an opportunity for problem-solving. Determines need for further intervention.

Consult with certified wound, ostomy, continence nurse.

Rationale: Helpful in choosing products appropriate for patient’s particular rehabilitation needs, including type of ostomy, physical/mental status, abilities to handle self-care, and financial resources.

Apply corticosteroid aerosol spray and prescribed antifungal powder as indicated.

Rationale: Assists in healing if peristomal irritation persists and fungal infection develops. Note: These products can have potent side effects and should be used sparingly.

Related FAQs

1. Why would you need a colostomy?

A colostomy may be needed if you cannot pass stools through your anus. This could be the result of an illness, injury or problem with your digestive system. You may have a colostomy to treat: bowel cancer.

2. Can you poop after a colostomy?

Pooping will be different with a colostomy bag. Immediately after your surgery, your anus may continue to expel poop and other fluids that were left inside. But new poop will now exit through your stoma. Most people will be able to feel their bowels move and know when poop is about to come out.

3. What is the difference between a colostomy and ostomy?

A colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall.

4. What part of the bowel would a colostomy be placed?

Colostomy is a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Stools moving through the intestine drain through the stoma into a bag attached to the abdomen.

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