照顧一位極低體重合併無肛症早產兒之護理經驗

本文旨在敘述照顧一位23週，出生體重為512公克之極低體重合併無肛症之早產兒護理經驗，護理期間自2017年7月16至9月30日，採用系統性評估，針對個案的生理、行為及家庭狀況等三方面評估，照護期間以直接護理、觀察與案父母會談等方式收集資料，確立護理問題有：低效性呼吸型態／與肺部發育不全有關、皮膚完整性受損／與人工造口袋外滲有關、高危險性父母－嬰兒依附關係改變／與早產兒住院有關、照顧者角色緊張／與案母缺乏照顧經驗有關。筆者於照護期間經由個別性的護理措施，以穩定個案的生命徵象、滿足生理需求、腸造口照護及改善皮膚受損程度，並鼓勵案父母參與共同照護計畫，以建立親子依附的連結，主動提供案父母有關早產兒及腸造口等居家照護之相關資訊，以減輕父母的焦慮及提升育兒信心。希望藉由此次照護經驗，提供同仁在臨床照護上之參考，並建議定期舉辦有關早產兒腸造口護理之相關課程，使護理人員在照護有腸造口早產兒時，能提供更專業的知識技能，並有系統地給予出院準備計畫，以減輕照顧者的壓力，進而提升居家照護能力。

關鍵字

早產兒；無肛症；腸造口；親子依附

並列摘要

This article described the caring for experience of a 23-week preterm infant with extremely-low-birth-weight of 512g at birth and imperforate anus, from July 16 to September 30,2017. With systemic assessment the patient's physical, behavioral and family conditions are evaluated. We collected data by direct care, observation and conservation with the patient's parents during nursing care, and the following nursing problems are established:(1)Inefficient breathing pattern/ is related to pulmonary hypoplasia;(2)Impaired skin integrity/ is associated with extravasation of stomy application;(3)High risk of parent-infant detachment/ is related to hospitalization of premature infants;(4)Tension of Caregiver/ is due to lack of parental care experience. Through individualized nursing interventions during the period of care, the author aimed to stabilize the vital signs and to fulfill the physiological needs of the patient, stomy care and enhance skin barrier from damage and encourage parents to participate in the joint-care plan in order to create a link between the parent and child. We also Provide the parents the information of home care such as prematurity and enterostomy care on their own initiative to alleviate the anxiety of their parents and to enhance parental confidence. It is hoped that this experience of care will provide a reference for the colleagues in clinical care and regular lecture about care of stomy in preterm infant is recommended so that nursing staff can possess more professional Knowledge and skills, and systematically provide discharge preparation plans to alleviate the pressure of caregivers, thereby enhancing home care capacity.

並列關鍵字

prterm infant ； Imperforate Anus ； ileostomy ； parent-child attachment

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照顧一位極低體重合併無肛症早產兒之護理經驗

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