- 期刊
照顧智能障礙血液透析罹患膀胱癌之護理經驗
Nursing Experience of Caring a Mentally Retarded Patient with Carcinoma of the Urinary Bladder and Hemodialysis
摘要
本篇個案報告主要描述一位智障血液透析病人，因罹患膀胱癌需住院進行經尿道膀胱腫瘤切除術之照護經驗。護理期間自2009年8月24日至27日，以外科專科護理師的角色，運用Gordon十一項健康功能型態為評估架構，在病人住院期間透過會談、觀察、傾聽等方式收集資料，發現病人主要之健康問題有：焦慮與害怕施行手術及進入手術室無人陪伴有關、疼痛與經尿道施行手術後導尿管留置有關、照顧者角色緊張與受照顧者智能障礙及罹患癌症有關。在護理過程中，透過護病關係的建立、傾聽並鼓勵病人說出心中感受、結合家屬之支持力量及增加病人對手術的認識；當害怕或緊張時，病人會用聽音樂的方法來轉移注意力，使其情緒得以宣洩，並能面對開刀所帶來的不適；術後運用疼痛控制技巧減輕疼痛，結果病人以簡易10分疼痛量表評估表示疼痛指數由9分下降為1分；另藉由提供手術相關訊息、介紹病友及成功案例、鼓勵家屬提出問題等方式，以增加家屬對疾病和手術之認知進而減輕照顧者的緊張。然而照護一位智能障礙的病人，在短時間內透過家屬所提供的訊息，和病人及家屬建立良好之護病關係，並進一步藉由醫護團隊給予病人適當的醫療及護理，是團隊所要努力的方向。
並列摘要
We reported our nursing experience while taking care of a mentally retarded patient with transitional cell carcinoma (TCC) of the urinary bladder (UB) who is undergoing hemodialysis (HD) due to end stage renal disease (ESRD). The follow-up was from Aug 24, 2009 to 27 Aug, 2009. We used Gordon's 11-item health assessment to evaluate this patient via interviews, observation, and listening. We collected data and found that the major healthy problems of the patient included anxiety and fear about the operation together with a fear of entering the operation room without company, (2) fear of the pain after the operation and (3) the nervousness of his family. All these problems were related to poor communication with the patient, who was mentally retarded and was suffering from TCC of UB. During the process of nursing care, we built a good nurse-patient relationship, listened to the patient and encouraged the patient to express his feelings. In addition, with support from his family, we did our best to help the patient understand the surgical procedure, and reduce his feelings of fear and anxiety by enjoying music. The music was able to decrease tension/nervousness and he was able to overcome the discomfort after the operation. After operation, we used pain control skills to decrease the pain score from 9 to 1. In addition, we provided surgery-related information and our successful nursing experience with similar cases to help encourage his family to raise any questions they had. These approaches also helped the family to understand the whole procedure, which aided in reducing the nervousness of the patient and his family. We report here our nursing experience while taking care of a mentally retarded patient suffering from TCC of the UB and under HD due to ERSD. He received a transurethral resection of the bladder tumor. From this case, we realized that a team work together providing adequate medical and nursing care are important when treating such a patient.