照護一位膀胱全切除合併迴腸膀胱造廔病人之手術全期護理經驗

A Perioperative Nursing Experience of A Bladder Cancer Patient Receiving Cystectomy and Ileal Conduit

張令瑋(Ling-Wei Chang) ； 王麗卿(Li-Ching Wang) ； 辜漢章(Han-Chang Ku)

《嘉基護理》 17卷1期 (2017/06) Pp. 11-23

摘要

本文探討一位73歲男性個案因解血尿檢查出罹患膀胱癌，因害怕面對手術而選擇逃避，後因血尿嚴重合併解尿困難及持續疼痛，最後終需接受膀胱全切除合併迴腸膀胱造瘻手術，所面臨的心理衝擊與調適過程之護理經驗。筆者於2014年12月3日至22日照護期間運用Gordon十一項功能性健康型態作為評估架構，經由觀察、會談、身體評估及病歷閱覽等方式收集與資料分析，確立個案手術前期有焦慮、手術中期有潛在危險性損傷、手術後期有急性疼痛及身體心像改變等健康問題。針對術前焦慮提供專業的衛教及心理支持，使個案有信心接受手術；術中個案接受長時間全身麻醉，故提供高品質安全防護措施；術後急性疼痛及身體心像改變，提供疼痛評估及教導個案及家屬迴腸膀胱造瘻照護，協助個案渡過整個手術全期。此外，筆者在整個手術全期期間透過傾聽、陪伴與個案建立良好的人際關係，發揮護理專業的角色，提供醫療照護資訊，使個案能調整心態，正向面對疾病造成的身體心像、排尿系統的改變及害怕死亡所產生的恐懼，進而提升使個案具更正向的疾病適應。

關鍵字

膀胱全切除 ； 迴腸膀胱造瘻 ； 手術全期護理

並列摘要

This case report described the perioperative nursing experience for a 73-year-old male with hematuria caused by bladder cancer. Because the patient wss feared to face the surgery, he chose to escape. But finally he received cystectomy and ileal conduit after voiding difficulty. The author applied direct observation, conversation, physical examination and chart review to collect the data. The nursing period was from December 3, to 22, 2014. The method of Gordon’s Functional Health patterns was applied to assess the patient’s condition. Four health-related problems were identified: anxiety, risk for injury, acute pain and body image disturbance. Nursing interventions for this case included providing: psychological support and skillful education to reduce the patient’s anxiety, providing pain assessment and teaching the technique of how to care the cystostomy with the patient and families. On the other way, the author played an important role in building a good relationship with the patient during the nursing period in order to allow the patient be more positive in accepting his altered body image, changed urinary elimination system and overcame the fear of death. In addition, relying on the teamwork of professional treatment and family support, we provided the patient to gain confidence and maintain a better quality of life.

並列關鍵字

cystectomy ； ileal conduit ； perioperative nursing

參考文獻

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