照顧一位因飲食習慣無法改變造成縮胃手術失敗個案之照護經驗

本文旨在照護一位肥胖症行可調節式胃束帶手術後的年輕男性，返家後因飲食習慣未改變，導致胃黏膜微血管破裂及出血，故再度入院之護理經驗。筆者期間照護於2017年8月26日至10月3日，以生理、心理、社會、靈性及健康信念之整體性護理評估為指引，經由收集過去病史、查閱病歷、實際參與個案照護、會談等方式收集資料，確立個案有疼痛、無效性自我健康管理、焦慮健康問題。對於無法執行正確健康飲食的病人，在照護期間與個案建立良好治療性關係，以同理、關懷的態度，將飲食控制、規律運動之減重觀念導入疾病護理，使個案了解疾病與飲食控制的重要性，協同營養師擬定合適飲食計劃，選擇適合個案攝取營養的食物，促進傷口癒合；並照會精神科醫師，探索其焦慮原因，適時地給予個案正向鼓勵，以增強個案正確飲食觀念，並且持續追蹤減重術後個案執行健康飲食狀況，提升肥胖減重術後個案自我照護品質，建議照護此類個案時，能運用跨團隊照護模式，促使病人做好自我健康管理，導正其偏差飲食觀念，使病人能盡早回歸正常的家庭生活。

關鍵字

肥胖症；可調節式胃束帶手術；疼痛；自我健康管理失效；焦慮

並列摘要

This case report aims to share the experience of caring a young man who had bleeding of gastric mucosa after adjustable gastric banding surgery for morbid obesity. As a result of diet habit without change after surgery, his gastric mucosa got bleeding and re-admitted to the hospital. The nursing assessment of different aspects including physical, psychological, social, spiritual and health beliefs were collected from August 26 to October 3 in 2017. Through collecting patient’s past medical history, reviewing his medical records, inviting the patient to participate in nursing care, and interviewing, the author identified that the patient had problems about pain control, ineffective self-health management, and anxiety. For patients who could not follow the suggested healthy diet, the author used empathy and caring to establish a good therapeutic relationship and recommended the patient to develop a regular exercise in losing weight. The author also coordinated with a dietitian to design an appropriate diet and select feasible foods to promote wound healing. All the strategies helped the patient to understand the importance of diet control in managing such a disease. For the problem of anxiety, consulting psychiatrist to explore the reasons for anxiety and timely giving encouragement to reinforce the healthy diet were ways to improve the self-care quality after surgery for morbid obesity. Using multi-disciplinary care model to care, encouraging the patient to do self-management, and correcting the wrong diet could be helpful for the patient to return to normal family life as soon as possible.

並列關鍵字

obesity ； adjustable gastric banding surgery ； pain ； ineffective self-health management ； anxiety

參考文獻

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照顧一位因飲食習慣無法改變造成縮胃手術失敗個案之照護經驗

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