一位脊髓損傷併頑固性壓瘡行結腸造口患者之護理經驗

A Nursing Experience of a Patient with Spinal Cord Injury Complicated with Intractable Pressure Ulcers Receiving Colostomy

江郁芬(Yu-Fen Chiang) ； 劉錦茹(Chin-Ju Liu)

《志為護理-慈濟護理雜誌》 10卷4期 (2011/08) Pp. 109-120

https://doi.org/10.6974/TCNJ.201108.0109

摘要

本文係描述一位脊髓損傷併頑固性壓瘡患者，曾多次入院接受清瘡手術治療，此次又因第三級壓瘡而需接受結腸造口手術治療。護理期間爲2008年8月18日至9月3日，筆者運用Gordon十一項功能性健康型態爲評估工具，藉由觀察、會談及身體評估等技巧，收集個案之相關資料分析後，確認個案健康問題包含：皮膚完整性受損、現存性感染、身體心像紊亂及自我照顧能力缺失。在護理過程中，協助個案與家屬了解頑固性壓瘡成因與感染徵象，學會傷口自我照護，並扮演傾聽、支持及諮詢的角色，引導其訴說擔心害怕的事，重新調適身體心像改變的衝擊，進而讓個案願意學習結腸造口自我照護相關知識與自我照顧技巧，對出院後長期照顧不再擔心，並對未來生活重獲信心。

關鍵字

脊髓損傷 ； 頑固性壓瘡 ； 結腸造口

並列摘要

This article described a nursing care experience of a patient with spinal cord injury complicated with intractable pressure ulcers. The patient was admitted several times for pressure ulcers debridement, and admitted again due to stage Ⅲ pressure ulcers and required colostomy. The author applied the Gordon 11-item functional assessment tool with direct personal nursing care, using skillful physical evaluation, conversation and close observation from August 18(superscript th) to September 3(superscript rd), 2008. The patient's problems were identified as followed: impaired skin integrity, infection, body image disturbance and self-care deficit. During the nursing care period, the patient helped the patient and family to understand the causes of intractable pressure ulcer and the infection signs, hence tending to the infection. By listening, supporting, and counseling, the patient could face anxiety, accepted body image changes and learnt how to do self-care. Eventually, it would provide this patient informationa regarding colostomy self-care and other self-care skills, relieving the patient from anxiety ofregarding future long term self-care and have confidence in leading a quality life.

並列關鍵字

colostomy ； intractable pressure ulcers ； spinal cord injury