照顧一位行經皮腎造口截石術個案之手術全期護理經驗

本文探討一位小兒麻痺個案因右側腰部疼痛及血尿至急診求治，初步影像學檢查發現為右側泌尿道結石造成嚴重急性腎盂腎炎，先予置放腎造口管及抗生素治療以改善其腎水腫問題後，進一步安排經皮腎造口截石術之手術全期護理經驗。照護期間為2019年07月12日至07月19日。運用Gordon十一項健康功能評估為架構，藉由會談、身體評估、術前訪視及查閱病歷等進行整體性評估，發現患者對於手術及疾病認知上缺乏足夠的資訊，而產生心理焦慮；因肢體活動受限，增加手術中姿勢擺位困難度。因此，歸納患者主要的護理照護問題有：「焦慮」、「潛在危險性手術情境傷害」、「增進知識的準備度」等健康問題。照護過程中筆者以手術室全期護理師角色，於術前訪視提供手術相關訊息，增加患者對手術的認知，緩解其焦慮；手術中患者因小兒麻痺症關節活動受限，增加其手術過程姿勢擺位之困難度，於術前訪視時，評估其關節活動受限情形，手術過程中運用支撐性襯墊，以防止壓力性損傷發生，預防潛在性危險性損傷；術後提供患者預防結石再復發之飲食衛教，如攝取足夠之飲水量及正確食物的選擇，促進術後自我照顧能力。期盼藉由此篇護理經驗提供給日後照護類似患者之護理人員參考。

關鍵字

經皮腎造口截石術；潛在危險性手術情境傷害；增進知識的準備度；手術全期護理經驗

並列摘要

This article focuses on the perioperative nursing experience in a patient of poliomyelitis, who received percutaneous nephrolithotomy for right urinary tract stones complicated with acute pyelonephritis and hydronephrosis. The nursing period was from July 12 to 19, 2019. Data were collected through physical assessments, preoperative ward visit, and chart review based on the framework of Gordon's 11 functional health patterns. The author recognized that the patient lacked sufficient information on the disease and surgery; and had the issue of restriction of joint movement and difficulty in posture arrangement. It was concluded that the major nursing problems included "anxiety", " potential risk of operative injury " and " readiness for enhanced knowledge ". As a role of the perioperative caring nurse, the author provided essential surgery-related information to increase the patient's cognition in surgery to ease his anxiety; and made evaluations of joint movement limitation to take proper care in posture and positioning during surgery in the preoperative visit. During operation, delicate posture arrangement was achieved by multiple supporting pads to prevent possible pressure injuries. The postoperative health education was provided, including enough water and food selection to prevent renal stones recurrence and how to promote his self-care ability. The experience can serve as a reference for nursing care in patients with the similar conditions in the future.

並列關鍵字

percutaneous nephrolithotomy ； potential risk of operative injury ； readiness for enhanced knowledge ； perioperative nursing

延伸閱讀

江素眞、蔡麗紅（2009）。一位外籍勞工接受經皮腎造廔截石術之護理經驗。長庚科技學刊，(10)，73-82。https://doi.org/10.6192/CGUST.2009.6.10.6
林美伶、周學智、徐曉雲、陳麗玲（2016）。照顧一位顱內動脈瘤破裂個案出院準備服務之護理經驗。榮總護理，33(1)，50-59。https://doi.org/10.6142/VGHN.33.1.50
胡閔閔、林佳蓉（2016）。照護一位接受腎移植個案手術全期護理經驗。領導護理，17(1)，61-73。https://doi.org/10.29494/LN.201603_17(1).0006
周稜穎、林昀、葉淑敏（2020）。照護一位基底核出血術後病人於加護病房之護理經驗。領導護理，21(2)，31-45。https://doi.org/10.29494/LN.202006_21(2).0004
Huang, W. H., Jiann, B. P., Lee, Y. H., Wu, T. T., Yu, C. C., Tsai, J. Y., Chou, C. P., & Huang, J. K. (2003). Risk Factors of Massive Bleeding After Percutaneous Nephrolithotomy and Its Management. 臺灣泌尿科醫學會雜誌, 14(2), 65-71. https://www.airitilibrary.com/Article/Detail?DocID=10163220-200306-14-2-65-71-a

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