一位行永久性結腸造口術個案之手術全期護理經驗

The Perioperative Nursing Experience of a Patient Who Underwent Colostomy

楊秋萍(Chiu-Ping Yang) ； 莊阿月(A-Yueh Chuang)

《腫瘤護理雜誌》 9卷2期 (2009/12) Pp. 75-87

https://doi.org/10.6880/TJON.200912_9(2).07

摘要

本文是一位65歲個案因初患直腸癌時害怕手術，選擇先行化學療法，之後再度復發，進而行直腸癌切除併永久性結腸造口術之手術全期護理經驗，筆者於2007年6月4日至6月16日照護期間，藉由訪視、實際觀察、會談及羅式適應模式為整個護理過程評估架構，從手術前期、中期、後期進行資料收集，分析出個案術前的焦慮、術中的潛在性損傷、術後的自我照護知識增進的準備度及身體心像改變問題，筆者藉由手術全期護理師角色，運用支援、教育性技巧，使個案術前不僅疑慮減輕、摒除迷思接受手術，術中提供全程防護確保個案手術安全而無潛在性傷害發生，術後延伸的護理問題經與個案、家屬共同討論設定護理計劃，並運用醫護團隊力量、親情支援系統得以自我調適重拾信心，進而學到自我照顧的能力，並於出院後恢復日常生活，維持良好生活品質。

關鍵字

羅式適應模式理論 ； 永久性腸造口 ； 手術全期護理

並列摘要

This is a report of perioperative nursing experience of a 65-year old rectal cancer patient who initially refused operation and received chemotherapy, but later underwent tumor resection and permanent colostomy procedures due to recurrence. Through visit, direct observation and interview during the period from June 4th to 16th in 2007, the author collected data and constructed the framework using Roy's adaptation model. The nursing problems identified were preoperative anxiety, potential damage during operation, readiness of self care knowledge and cope with body image changes after surgery. Support and skillful education by the author before operation alleviated the patient's anxiety and clarified his confusion. Continuous monitoring to assure no potential damage during the operation and; execution of nursing plan combing the effort of nursing staff, patient and family after the operation successfully solved the problems postoperatively. Moreover, attributed to the team work of medical and nursing professional and family support, the subject gained confidence and acquired self-care ability. Consequently, the patient returned back to normal life and maintained good life guality after discharge uneventfully.

並列關鍵字

Roy's adaptation model ； permanent colostomy ； peri-operative nursing