- Deficient Knowledge related to lack of exposure/unfamiliarity with colostomy/ileostomy as evidenced by verbalizes incorrect/inaccurate statements regarding colostomy/ileostomy
- Disturbed Body Image related to alteration in appearance and loss of control over bowel movements as evidenced by verbalization of concerns in appearance, sexuality, relationships, lifestyle changes and refusal to participate in ostomy care
- Dysfunctional Gastrointestinal Motility related to Colostomy placement, Ileostomy placement as evidenced by Hypoactive bowel sounds and increased gastric residual
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes poor understanding Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition -Avoiding eye contact or remaining silent during teaching | Deficient Knowledge related to lack of exposure/unfamiliarity with colostomy/ileostomy as evidenced by verbalizes incorrect/inaccurate statements regarding colostomy/ileostomy | Patient will demonstrate the ability to remove, clean, and reapply a new ostomy device. Patient will verbalize dietary changes to control stool output. Patient will recognize signs of a complication and seek immediate assistance. | 1. Encourage confidence in the patient. Patients may lack confidence in performing ostomy care. Boost confidence by having them participate in care and providing positive feedback. 2. Educate on ostomy care. Ensure the patient understands to empty their pouch when it is ⅓-½ full to prevent pouch loosening. Educate on how to bathe, how to prevent gas and odors by not eating certain foods and other nuances. 3. Manage complications. Complications such as bowel obstructions, diarrhea, and short bowel syndrome can develop. Educate the patient on signs and symptoms and when to contact their provider. 4. Have the patient demonstrate. The best way to ensure ostomy teaching has been effective is to observe the patient perform emptying, cleaning, and changing their ostomy system. 5. Coordinate with an ostomy nurse. A nurse who specializes in ostomy care is a wealth of information in teaching the patient all about their colostomy and ileostomy. The nurse can also recommend supplies that can make managing their ostomy easier. | Patient demonstrated the ability to remove, clean, and reapply a new ostomy device. Patient verbalized dietary changes to control stool output. Patient recognized signs of a complication and seek immediate assistance. |
| Subjective data: Verbalization of concerns in appearance, sexuality, relationships, lifestyle changes Objective data: -Negative self-concept -Refusal to participate in ostomy care -Chosen isolation from socialization | Disturbed Body Image related to alteration in appearance and loss of control over bowel movements as evidenced by verbalization of concerns in appearance, sexuality, relationships, lifestyle changes and refusal to participate in ostomy care | Patient will begin to demonstrate comfort with body image as evidenced by viewing/touching ostomy and performing stoma care. Patient will verbalize acceptance of change in body image. Patient will seek information on navigating life with an ostomy. | 1. Take a positive approach. Always provide ostomy care with confidence and a positive attitude. Never show facial expressions of disgust so as not to cause further harm to the patient’s ego. 2. Help the patient visualize a normal life. Living with an ostomy does not have to affect everyday activities. Patients may be relieved to learn that they can still wear clothing they prefer, eat the foods they love, and participate in sports such as swimming or weightlifting. Remind the patient there are many ways to hide their ostomy if they prefer. 3. Consider a support group. Adapting to a colostomy or ileostomy takes time. Talking to others with ostomies who understand the difficulties can be empowering. Support groups may be in person or online and can provide tips and advice to ease the transition. 4. Recommend counselling. Depression and anger can develop, and the patient may grieve their loss of appearance. A patient struggling with acceptance of their body image may require counselling to overcome challenges to their lifestyle and intimacy. | Patient demonstrated comfort with body image as evidenced by viewing/touching ostomy and performing stoma care. Patient verbalized acceptance of change in body image. Patients seek information on navigating life with an ostomy. |
| Subjective data: Verbalizes abdominal discomfort Objective data: -Abdominal cramping -Abdominal pain -Hypoactive bowel sounds -Diarrhea -Increased gastric residual -Constipation -Gas -Nausea -Vomiting -Accelerated gastric emptying | Dysfunctional Gastrointestinal Motility Related to Colostomy placement, Ileostomy placement as evidenced by Hypoactive bowel sounds and increased gastric residual | Patient will be free from any signs of dysfunctional gastrointestinal motility like diarrhoea, gas, and changes in bowel habits. Patient will show no signs of intestinal obstruction and postoperative ileus. | 1. Administer IV fluids. Postoperative ileus is often resolved through supportive measures such as IV fluid and electrolyte replacement. 2. Encourage adequate intake of soluble fiber. After colostomy or ileostomy, a diet high in soluble fiber, like apples, bananas, oats, rye, and barley, is recommended as this can significantly improve motility problems. Instruct the patient to avoid foods rich in insoluble fiber like bran, cereals, legumes, dried beans, and certain fruits and vegetables. 3. Monitor the patient for signs and symptoms of fluid and electrolyte imbalance. As peristalsis returns after an ileostomy or colostomy procedure, drainage in the stoma can increase (high output) as the patient has lost the absorptive function of some parts of the intestines. 4. Encourage ambulation. Early ambulation is very important following bowel resection to prevent or reduce ileus and promote bowel motility. 5. Administer medications as indicated. Medications like antidiarrheals and antimotility medications that reduce stoma output or gut secretions may be indicated to slow bowel motility in patients experiencing high stoma output after colostomy or ileostomy procedures. | Patient free from signs of dysfunctional gastrointestinal motility like diarrhoea, gas, and changes in bowel habits. Patient shown no signs of intestinal obstruction and postoperative ileus. |