Ileostomy & Colostomy Nursing Care Plan
Ostomy care: stoma assessment, peristomal skin, output monitoring and self-care teaching.
Quick answer
A Ileostomy & Colostomy nursing care plan centers on assess stoma viability and function; protect peristomal skin from effluent; maintain fluid and electrolyte balance, especially with an ileostomy. Priority nursing diagnoses are Impaired skin integrity, Disturbed body image, Deficient knowledge, Risk for deficient fluid volume. The plan below gives assessment cues, measurable goals, 3 intervention sets with rationales, and patient teaching.
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 numbers to know
Normal stoma
Beefy red and moist; pale suggests anemia, dusky or black suggests ischemia and is an emergency.
Skin barrier
Cut the barrier to within about 1/8 inch of the stoma so no skin is exposed to effluent.
Ileostomy fluids
Encourage extra fluid and salt; report output over 1,000–1,500 mL/day or signs of dehydration.
Food blockage
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.
Nursing assessment
Subjective data
- 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 data
- 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
Key nursing diagnoses
Goals and expected outcomes
- 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.
Nursing interventions and rationales
Stoma and skin care
- 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.
Fluid, electrolytes and nutrition
- 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.
Adaptation and teaching
- 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 and family 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.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Ileostomy & Colostomy questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Surgery & Perioperative care plans
Plans that share these nursing diagnoses
Care plan writing guides
Common questions
What are the nursing diagnoses for Ileostomy & Colostomy?
Priority nursing diagnoses for Ileostomy & Colostomy: Impaired skin integrity; Disturbed body image; Deficient knowledge; Risk for deficient fluid volume.
What are the nursing interventions for Ileostomy & Colostomy?
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. 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.
What are the nursing care goals for Ileostomy & Colostomy?
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.
What should you assess in a patient with Ileostomy & Colostomy?
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; 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
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