照顧一位手術後併發腸皮膚瘻管之失智症個案的護理經驗

本文探討一位患有中度失智症，且因腸阻塞術後併發腸皮膚瘻管合併症的護理經驗。護理期間為2014年5月21至6月20日，運用Gordon十一項評估進行資料收集，確立皮膚完整性受損、疼痛、營養不均衡及主要照顧者無助感等護理問題。以減少瘻管周圍皮膚受到排泄物侵蝕、低壓抽吸排泄物與改變換藥方式以促進舒適度；以同理心接受個案對於疼痛情緒反應及換藥分散注意力緩解疼痛；給予個別飲食衛教及適合管灌飲食，使傷口逐漸縮小與病況穩定，能接受瘻管縫合手術；對照顧者給予困難傷口衛教、提供心情抒發及支持，以提升生活品質。期藉此個案照護經驗分享，共同提升照護品質。

關鍵字

失智症；腸皮膚瘻管；手術後

並列摘要

This study presented the nursing experiences of a moderate dementia patient complicated with postoperative enterocutaneous fistula. The nursing period lasted between May 21^(st) and June 20^(th), 2014. Gordon 11 functional health patterns were applied to assess patient's condition, and the following nursing problems were identified: impaired skin integrity, pain, nutritional imbalance, and helplessness in the primary caregiver. To accommodate these problems, the following nursing care were provided: reduce excrement leakage on the skins surrounding the fistula, facilitate comfort by employing low pressure suction and changing dressing methods; relief pain by approaching the patient's pain reaction with empathy and distract the patient's attention when dressing; reduce the wound and stabilize the condition by offering appropriate tube feeding diet and individualized health care to prepare for fistula closure; educate caregiver on difficult wound care and enhance the caregiver's life quality by providing emotional relief and support. The nursing experience can serve as a reference for nursing future patients with similar conditions.