NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs
May be related to
- Lack of exposure/recall information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; statement of misconception/misinformation
- Inaccurate follow-through of instruction/performance of ostomy care
- Inappropriate or exaggerated behaviors (e.g., hostile, agitated, apathetic, withdrawal)
Desired Outcomes
Knowledge: Disease Process (NOC)
- Verbalize understanding of condition/disease process, prognosis, and potential complications.
Knowledge: Treatment Regimen (NOC)
- Verbalize understanding of therapeutic needs.
- Correctly perform necessary procedures, explain reasons for the action.
- Initiate necessary lifestyle changes.
10 Ileostomy & Colostomy Nursing Care Plan (NCP)
- Risk for Impaired Skin Integrity — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Disturbed Body Image — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Acute Pain — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Impaired Skin Integrity — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Deficient Fluid Volume — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Imbalanced Nutrition — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Sexual Dysfunction — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Disturbed Sleep Pattern — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Constipation/Diarrhea — Ileostomy & Colostomy Nursing Care Plan (NCP)
- Knowledge Deficit — Ileostomy & Colostomy Nursing Care Plan (NCP)
Knowledge Deficit — Ileostomy & Colostomy Nursing Care Plan (NCP)
| Nursing Interventions | Rationale |
| Evaluate patient’s emotional, cognitive, and physical capabilities. | These factors affect patient’s ability to master care-tasks and willingness to assume responsibility for ostomy care. |
| Include written/picture (photo, video, Internet) learning resources. | Provides references for obtaining support, equipment, and additional information after discharge to support patient efforts for independence in self-care. |
| Review anatomy, physiology, and implications of surgical intervention. Discuss future expectations, including anticipated changes in character of effluent. | Provides knowledge base from which patient can make informed choices, and offers an opportunity to clarify misconceptions regarding individual situation. (Temporary ileostomy may be converted to ileoanal reservoir at a future date; ileostomy and ascending colostomy cannot be regulated by diet, irrigations, or medications.) |
| Instruct patient/SO in stomal care. Allot time for return demonstrations and provide positive feedback for efforts. | Promotes positive management and reduces risk of improper ostomy care/development of complications. |
| Recommend increased fluid intake during warm weather months. | Loss of normal colon function of conserving water and electrolytes can lead to dehydration and constipation. |
| Discuss possible need to decrease salt intake. | Salt can increase ileal output, potentiating risk of dehydration and increasing frequency of ostomy care needs/patient’s inconvenience. |
| Identify symptoms of electrolyte depletion, e.g., anorexia, abdominal muscle cramps, feelings of faintness or “cold” in arms/legs, general fatigue/weakness, bloating, decreased sensations in arms/legs. | Loss of colon function altering fluid/electrolyte absorption may result in sodium/potassium deficits requiring dietary correction with foods/fluids high in sodium (e.g., bouillon, Gatorade) or potassium (e.g., orange juice, prunes, tomatoes, bananas, Gatorade). |
| Discuss need for periodic evaluation/administration of supplemental vitamins and minerals as appropriate. | Depending on portion and amount of bowel resected, lack of absorption may cause deficiencies. |
| Stress importance of chewing food well, adequate intake of fluids with/following meals, only moderate use of high-fiber foods, avoidance of cellulose. | Reduces risk of bowel obstruction, especially in patient with ileostomy. |
| Review foods that are/may be a source of flatus (e.g., carbonated drinks, beer, beans, cabbage family, onions, fish, and highly seasoned foods) or odor (e.g., onions, cabbage family, eggs, fish, and beans). | These foods may be restricted or eliminated, based on individual reaction, for better ostomy control, or it may be necessary to empty the pouch more frequently if they are ingested. |
| Identify foods associated with diarrhea, such as green beans, broccoli, highly seasoned foods. | Promotes more even effluent and better control of evacuations. |
| Recommend foods used to manage constipation (e.g., bran, celery, raw fruits), and discuss importance of increased fluid intake. | Proper management can prevent/minimize problems of constipation. |
| Discuss resumption of presurgery level of activity. Suggest emptying the ostomy appliance before leaving home and carrying a fanny pack with fresh supplies. Recommend resources for obtaining attractive appliances and decorative cummerbunds as appropriate. | With a little planning, patient should be able to manage same degree of activity as previously enjoyed and in some cases increase activity level. A cummerbund can provide both physical and psychological support when patient is involved in activities such as tennis and swimming. |
| Talk about the possibility of sleep disturbance, anorexia, loss of interest in usual activities. | “Homecoming depression” may occur, lasting for months after surgery, requiring patience/support and ongoing evaluation as patient adjusts to living with a stoma. |
| Explain necessity of notifying healthcare providers and pharmacists of type of ostomy and avoidance of sustained-release medications. | Presence of ostomy may alter rate/extent of absorption of oral medications and increase risk of drug-related complications, e.g., diarrhea/constipation or peristomal excoriation. Liquid, chewable, or injectable forms of medication are preferred for patients with ileostomy to maximize absorption of drug. |
| Counsel patient concerning medication use and problems associated with altered bowel function. Refer to pharmacist for teaching/advice as appropriate. | Patient with an ostomy has two key problems: altered disintegration and absorption of oral drugs and unusual or pronounced adverse effects. Some of the medications that these patients may respond to differently include laxatives, salicylates, H2receptor antagonists, antibiotics, and diuretics. |
| Discuss effect of medications on effluent, i.e., changes in color, odor, consistency of stool, and need to observe for drug residue indicating incomplete absorption | Understanding decreases anxiety regarding intestinal function and enhances independence in self-care. |
| Stress necessity of close monitoring of chronic health conditions requiring routine oral medications. | Monitoring of clinical symptoms and serum blood levels is indicated because of altered drug absorption requiring periodic dosage adjustments. |
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