一位行膀胱切除手術患者之手術全期護理經驗

本文旨在描述一位73歲罹患膀胱癌個案，接受根除性膀胱切除併重建手術，其身、心面臨衝擊的護理經驗。照顧期間為2014年12月30日至2015年1月8日，筆者在個案手術前病房訪視、手術期間直接照顧，以及手術後藉由每天至病房探視，以觀察、會談、身體評估及病歷查閱等方式進行資料收集，針對個案之生理、心理、社會及靈性層面進行整體性評估，確立個案有焦慮、潛在危險性手術情境傷害、疼痛及排尿型態改變等健康問題。運用術前訪視的陪伴與個案及家屬建立良好的護病關係，以手術相關資訊增進個案的信心並減低焦慮；於術中以最高標準的作業來減低多餘危害發生；運用疼痛十分量表確實評估疼痛指數，鼓勵其表達對疼痛的感受，並運用獨特性的護理措施來減輕疼痛；術後則教導會陰運動及手增加腹壓，協助膀胱排空，引導個案能正向面對疾病所帶來的改變。期望藉此護理經驗的分享，作為往後護理此類病人的參考。

關鍵字

膀胱癌；根除性膀胱切除併重建手術；手術全期

並列摘要

This report describes a perioperative nursing experience of caring for a 73-year-old patient with bladder cancer. The patient underwent radical cystectomy with reconstruction, with an imposed impact on the patient's physical and psychological well-being. From December 30, 2014 to January 8, 2015, through direct patient care, patient observation, and patient interview for data collection, the author identified the following major health problems: anxiety, potential risks for operation, pain, and urination pattern changes. The author visited the patient as a companion and built a good nurse-patient relationship for preoperative support. The patient obtained information regarding surgery, enhancing the patient's confidence in the operation and lowering overall anxiety. During the operation, we followed the highest standards to avoid potential risks secondary to operation. For pain management, the author used a 1-10 pain assessment scale to express the patient's level of pain. Individualized nursing interventions were applied to decrease the patient's pain level. Postoperative patient education included perineum exercise and manual abdominal compression to assist in emptying the bladder. The patient was encouraged to positively face the changes secondary to disease. The author hopes that this nursing experience can be shared and used as a reference for nurses taking care of patients with the same disease.

並列關鍵字

bladder cancer ； radical cystectomy with reconstruction ； perioperative nursing

參考文獻

Herr, K., Bursch, H., Ersek, M., Miller, L. L., & Swafford, K. (2010). Use of pain-behavioral assessment tools in the nursing home: Expert consensus recommendations for practice. Journal of Gerontological Nursing, 36(3), 18- 29. doi: 10.3928/00989134-20100108-04

Lin, Y. H., & Yang, M. S. (2010). The symptom experience of neobladder recipients: Characteristics and related factors. Journal of Nursing Research, 18(1), 26-33. doi: 10.1097/ JNR.0b013e3181ce5055

于大雄、黃柏堅、余宏政、蔡維明、黃昭淵、吳文正、廖俊厚 ( 2012 ) . 尿路上皮細胞癌 , 於郭漢崇總校閱 , 臨床泌尿學 ( 下冊 ) ( 再版 , 1372-1443 頁 ) . 台北市 : 金名。