Risk for Constipation/Diarrhea | Nursing Care Plan for Fecal Diversions

Nursing diagnosis: risk for Constipation/Diarrhea

Risk factors may include
Placement of ostomy in descending or sigmoid colon
Inadequate diet or fluid intake

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Bowel Elimination
Establish an elimination pattern suitable to physical needs and lifestyle with effluent of appropriate amount and consistency.

Nursing intervention with rationale:
1. Investigate delayed onset or absence of effluent. Auscultate bowel sounds.
Rationale: Postoperative paralytic or adynamic ileus usually resolves within 48 to 72 hours, and ileostomy should begin draining within 12 to 24 hours. Delay may indicate persistent ileus or stomal obstruction, which may occur postoperatively because of edema, improperly fitting pouch (too tight), prolapse, or stenosis of the stoma.

2. Inform client with an ileostomy that initially the effluent is liquid. If constipation occurs, it should be reported to enterostomal nurse or physician.
Rationale: Although the small intestine eventually begins to take on water-absorbing functions to permit a more semisolid, pasty discharge or absence of output may indicate an obstruction. Absence of stool requires emergency medical attention.

3. Review dietary pattern and amount and type of fluid intake.
Rationale: Adequate intake of fiber and roughage provides bulk, and fluid is an important factor in determining the consistency of the stool.

4. Review physiology of the colon and discuss irrigation management of sigmoid ostomy, if indicated.
Rationale: This knowledge helps client understand individual care needs. Note: Irrigation is usually not appropriate in the first 3 to 6 months after surgery.

5. Ascertain client’s previous bowel habits and lifestyle.
Rationale: Assists in formulation of a timely and effective irrigation schedule for client with a colostomy, if appropriate.

6. Demonstrate use of irrigation equipment per institution policy or under guidance of physician or certified WOC nurse.
Rationale: Irrigations may be done on a daily basis if appropriate, although there are differing views on this practice. Many believe cleaning the bowel on a regular basis is helpful. Others believe that this interferes with normal functioning. Most authorities agree that occasional irrigation is useful for emptying the bowel to avoid leakage when special events are planned.

7. Instruct client in the use of closed-end pouch or a patch, dressing or adhesive strip when irrigation is successful and the sigmoid colostomy effluent becomes more manageable, with stool expelled every 24 hours.
Rationale: Enables client to feel more comfortable socially and is less expensive than regular ostomy pouches.

8. Involve client in care of the ostomy on an increasing basis.
Rationale: Rehabilitation can be facilitated by encouraging client independence and control.