{
  "name": "Ileostomy & Colostomy",
  "slug": "ileostomy-colostomy",
  "url": "https://nursingplex.com/care-plans/ileostomy-colostomy",
  "category": "Surgery & Perioperative",
  "summary": "Ostomy care: stoma assessment, peristomal skin, output monitoring and self-care teaching.",
  "nursing_diagnoses": [
    "Impaired skin integrity",
    "Disturbed body image",
    "Deficient knowledge",
    "Risk for deficient fluid volume"
  ],
  "overview": [
    "An ostomy diverts stool through an abdominal stoma when the distal bowel must be bypassed, rested or removed — for colorectal cancer, inflammatory bowel disease, diverticulitis, trauma or obstruction. An ileostomy exits the small bowel and produces continuous liquid to pasty, enzyme-rich output; a colostomy exits the colon and produces output that becomes more formed the more distal the stoma.",
    "Because ileostomy effluent contains digestive enzymes and large volumes of fluid and sodium, the two biggest physiologic risks are peristomal skin excoriation and dehydration with electrolyte loss. High output above roughly 1,000–1,500 mL per day requires intervention.",
    "Nursing care combines technical pouching skill with intensive psychological support: body image disturbance, fear of odor and leakage, and worries about intimacy are nearly universal in the early weeks."
  ],
  "key_facts": [
    {
      "label": "Normal stoma",
      "text": "Beefy red and moist; pale suggests anemia, dusky or black suggests ischemia and is an emergency."
    },
    {
      "label": "Skin barrier",
      "text": "Cut the barrier to within about 1/8 inch of the stoma so no skin is exposed to effluent."
    },
    {
      "label": "Ileostomy fluids",
      "text": "Encourage extra fluid and salt; report output over 1,000–1,500 mL/day or signs of dehydration."
    },
    {
      "label": "Food blockage",
      "text": "Nuts, popcorn, corn and stringy vegetables can obstruct an ileostomy — chew well and introduce foods one at a time."
    }
  ],
  "nursing_priorities": [
    "Assess stoma viability and function.",
    "Protect peristomal skin from effluent.",
    "Maintain fluid and electrolyte balance, especially with an ileostomy.",
    "Teach independent pouch care before discharge.",
    "Support adaptation to altered body image and sexuality."
  ],
  "assessment": {
    "subjective": [
      "Reports of burning or itching around the stoma",
      "Expressions of disgust, embarrassment or reluctance to look at the stoma",
      "Concerns about odor, leakage, clothing, work and intimacy",
      "Reports of cramping, nausea or absent output suggesting blockage"
    ],
    "objective": [
      "Stoma color, size, height above skin and mucocutaneous junction integrity",
      "Type, volume and consistency of effluent",
      "Peristomal skin erythema, denudation, candidiasis or ulceration",
      "Signs of dehydration: dry mucous membranes, orthostasis, concentrated urine, low sodium or potassium",
      "Abdominal distention or absent output with a tense abdomen"
    ],
    "related_factors": [
      "Surgical creation of a stoma and altered elimination route",
      "Digestive enzymes in effluent contacting skin",
      "Poorly fitting appliance or frequent leakage",
      "Rapid transit and loss of colonic water reabsorption",
      "Change in body appearance and function"
    ]
  },
  "goals": [
    "The client will maintain intact peristomal skin.",
    "The client will demonstrate independent pouch emptying and changing before discharge.",
    "The client will maintain adequate hydration and normal electrolytes.",
    "The client will look at, touch and verbalize acceptance of the stoma."
  ],
  "interventions": [
    {
      "title": "Stoma and skin care",
      "points": [
        "Assess stoma color and output every shift in the early postoperative period; report dusky or black tissue immediately.",
        "Measure the stoma at each change while edema resolves and cut the barrier to fit closely.",
        "Cleanse with water only, dry thoroughly, and use skin barrier powder or paste for weeping skin.",
        "Empty the pouch when one-third full to prevent the weight from breaking the seal."
      ]
    },
    {
      "title": "Fluid, electrolytes and nutrition",
      "points": [
        "Record output volumes accurately; report ileostomy output above 1,000–1,500 mL/day.",
        "Encourage 2–3 liters of fluid daily with oral rehydration solutions for high output.",
        "Monitor sodium, potassium, magnesium and renal function.",
        "Advise chewing thoroughly and adding new foods one at a time; teach blockage management."
      ]
    },
    {
      "title": "Adaptation and teaching",
      "points": [
        "Involve a wound-ostomy-continence nurse early, ideally before surgery for stoma siting.",
        "Encourage the patient to look at and eventually handle the appliance stepwise.",
        "Discuss odor control, clothing, travel supplies, work and sexual activity openly.",
        "Provide written instructions, supply lists and ostomy association resources."
      ]
    }
  ],
  "patient_teaching": [
    "Demonstrate and have the patient return-demonstrate emptying and changing the pouch.",
    "Report a stoma that turns pale, dusky or black, or that retracts or prolapses.",
    "Report no output with cramping and distention — a possible obstruction.",
    "Drink extra fluids and replace salt during hot weather, exercise or illness."
  ]
}