照顧一位醫源性腸穿孔患者之護理經驗

本文主要在探討一位因健康檢查，無預期發生醫源性臨腸穿孔個案之護理經驗，護理期間為104年1月18日至1月30日，筆者於病人住院期間經由觀察、會談並運用Gordon十一項功能性健康型態評估方式收集資料，發現到主要護理問題有:（一）焦慮／對手術過程害怕及術後照護疑慮有關（二）疼痛／手術傷口及引流管留置（三）身體心像紊亂／腸造口導致身體外觀改變（四）知識缺失／腸造口護理及居家照顧資訊來源不足。在護理過程中首先經由與醫療團隊共同討論，幫助個案降低因手術帶來的疼痛不適症狀，並詳細說明疾病過程及治療方針，以減輕個案焦慮。其次經常探視陪伴個案，鼓勵個案說出內心感受、傾聽、同理、接受病人感受，與病人及家屬建立良好治療性的人際關係與信任感，共同設定護理計畫，並運用以往照護腸造口病患經驗的分享，促進個案自我調適及導向正向的情緒反應，期盼能將此護理經驗分享於護理專業及臨床工作的參考。

關鍵字

醫源性腸穿孔；腸造口

並列摘要

This article was a nursing experience of a patient with iatrogenic perforation. Care period 2015/1/18-2015/1/30. Primary care problem include: 1. Anxiety/fear of surgery and postoperative care concerns, 2. pain/surgical wounds and drainage tube indwelling. 3. body image disorders /intestinal stoma resulting in changes of physical appearance. 4. lack of knowledge/intestinal care and home care source of inadequate information. First, medical team discuss to design individual nursing plan to provide appropriate care measures in order to reduce surgical pain, discomfort symptoms and details of the disease process and treatment guidelines to reduce the case anxiety. Second, step by step to help case to express his feelings, patients and their families to establish a good treatment of interpersonal relationships, sharing the past care experience of intestinal stoma patients to promote self-adjustment and positive emotional response to case. This care experience as a reference for clinical work.