Nursing care plan fecal diversions

POSTOPERATIVE CARE OF ILEOSTOMY AND COLOSTOMY

I. Procedures—incontinent diversions (primary focus of this
plan of care), laporoscopic colectomy, and continent diversions,
such as the Kock pouch and the ileoanal reservoir
a. Ileostomy
i. Performed when the entire colon, rectum, and anus must
be removed, in which case the ileostomy is permanent;
or, a temporary ileostomy can be done to provide complete
bowel rest in conditions, such as with chronic colitis
and in some trauma cases.
ii. Most frequently performed for complications of inflammatory
bowel disease—Crohn’s disease and ulcerative
colitis—including intestinal perforation or intestinal stricture
causing obstruction, abscess, or massive hemmorhage
(Clark, 2005; Boehmke, 2006).
iii. May also be done because of intestinal trauma, polyps,
cancer, or complications from cancer (Clark, 2005).
b. Colostomy may be performed at several locations: the
ascending, transverse, descending, or sigmoid colon.
i. Ascending colostomy is positioned in the upper right side
of the abdomen.
ii. Transverse colostomy is positioned in the mid-to-right
upper abdomen.
1. Performed for diverticulitis, bowel obstruction, trauma,
or cancer of the descending or sigmoid colon
2. Usually temporary, but can be permanent when the lower
portion of the colon must be removed or permanently rested
iii. Descending/sigmoid colostomy is positioned in the lower
left side of the abdomen.
1. Most common permanent stoma with opening in the
lower end of the colon
2. Performed for cancer of rectum or sigmoid colon as
well as for diverticulitis, bowel obstruction, trauma,
and paralysis (Clark, 2004)

II. Etiology—dependent on underlying pathology requiring procedure

III. Statistics
a. Morbidity: An estimated 75,000 to 100,000 individuals undergo
ostomy surgery annually (Ringhofer, 2005); approximately
500,000 Americans have some type of stoma (Turnbull, 2003).
b. Mortality: Uncommon depending on age, reason for procedure
(such as Crohn’s disease versus penetrating trauma or
cancer), and comorbidities.

Care Settings
Care is handled in an inpatient acute care surgical unit.

Related Concerns
Cancer
Fluid and electrolyte imbalances
Inflammatory bowel disease (IBD): ulcerative colitis,
Crohn’s disease
Psychosocial aspects of care
Surgical intervention
Total nutritional support: parenteral/enteral feeding

Nursing Priorities
1. Assist client/significant other (SO) in psychosocial
adjustment.
2. Prevent complications.
3. Support independence in self-care.
4. Provide information about procedure, prognosis, treatment
needs, potential complications, and community resources.

Discharge Goals
1. Adjusting to perceived or actual changes.
2. Complications prevented or minimized.
3. Self-care needs met by self or with assistance depending
on specific situation.
4. Procedure, prognosis, therapeutic regimen, and potential
complications understood and sources of support identified.
5. Plan in place to meet needs after discharge.

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