照顧一位結腸癌術後病人因合併症接受腸造口手術之照護經驗

Nursing Experience of a Colorectal Cancer Patient with Stoma due to Complication of Laparoscopic Anterior Resection Surgery

盧怡婷(Yi-Ting Lu) ； 陳秀鉛(Shiou-Chian Chen)

《新臺北護理期刊》 21卷2期 (2019/09) Pp. 147-157

https://doi.org/10.6540/NTJN.201909_21(2).0013

摘要

本文描述一位結腸癌手術後因合併症導致非預期性置入腸造口，獨居需學習獨自照護腸造口個案之護理經驗。自西元2015年9月18日至2015年10月17日的護理期間，筆者運用Gordon十一項功能性健康型態評估、觀察、傾聽及溝通資料收集，確立存在健康問題有：一、急性疼痛／與手術傷口及引流管路牽扯有關、二、增進知識的準備度／與腸造口照護知識不足有關、三、身體心像紊亂／因腸造口導致身體外觀改變有關。護理過程中，教導非藥物方式的技巧，以減輕個案術後傷口的疼痛；與醫師及營養師等團隊合作，提供專業腸造口照護知識及營養諮詢，讓個案學會獨自照護腸造口；運用同理心引導個案說出內心感受、抒發負面情緒，於主動參與照護時給予正向鼓勵，使個案重新接受身體外觀的改變。因護理人員輪班調動，並非固定照顧個案，多以口頭傳遞及配合交班單，交代個案對於腸造口準備程度的進度，加上沒有明確規範，如臨床能制定腸造口照護的流程計畫，提供護理人員了解個案對於腸造口準備程度，以便提供詳細及完善的照護，期望透過此次護理經驗分享，提供給面臨相同照護問題的護理人員，以共同提升腸造口照護。

關鍵字

結腸癌 ； 腸造口 ； 急性疼痛

並列摘要

This article presents the nursing experience of a solitary patient with colorectal cancer who had an unexpected stoma due to the complication from his first surgery. During the nursing period from 18th September, 2015 to 17th October, 2015, using Gordon eleven-functional health patterns as the assessment tool, the data was collected through observation, listening and communication. Three major nursing problems were identified, including acute pain, insufficient knowledge, and disturbed body image. During the process of nursing care, the patient was taught non-medicine skill to relieve the acute pain over his abdominal wound after the surgery. The doctors and dietitians were teamed up to provide instructions of stoma care and nutrition information so that patient could learn how to take care of his stoma independently. To let him accept the change of his body, we communicated with the patient, guided him to talk about his feelings, and provided him with positive feedback when he was willing to take part of the stoma care. Due to different shift arrangement of nursing staff, personalized care was impossible. Thus, oral and recorded hand over was conducted on the progress of stoma preparation. No clear specification was provided. In view of this, the clinical care plan for stoma providing nursing staff in a more precise understanding on the progression of stoma preparation in order for a more detailed and precise care is needed. We share this nursing experience as an example for nurses on how to take care of this type of patients, hoping that we could evaluate the care of patients with stoma.

並列關鍵字

colorectal cancer ； stoma ； acute pain

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