照護一位接受結腸直腸癌切除術後早期進食之護理經驗

本文係探討一位76歲女性，接受結腸直腸癌切除術後早期進食之護理經驗，護理期間自2015年4月29日至5月9日，筆者藉由觀察、會談、身體評估及Gordon十一項功能性健康型態評估工具收集主客觀資料，整理分析後確認個案有：焦慮、疼痛、營養不均衡：少於身體所需等護理問題。藉由主動關懷、同理、傾聽引導個案表達內心感受，針對個案的需求於術前以資訊影像解釋手術過程及手術相關教育訊息，增加對病程發展的認知，並介紹病友分享經驗，建立支持系統，術後教導藥物及非藥物方式，提供有效疼痛控制照護，並透過營養飲食計畫，教導漸進式飲食，攝取足夠營養，促進術後傷口的復原狀況。筆者依所呈現之問題提供措施後，個案能主訴焦慮減輕、疼痛分數低於3分，能配合飲食計畫並於出院時體重未減輕。然而因結腸直腸癌術後早期進食於臨床現況並不普及，易導致個案產生疑慮及不安，另外因生理不適，更降低個案進食意願，建議可提供實證書面資料，並將臨床實務製成影片，藉此讓患者及家屬在接受手術前，能有更具體及完整之參考依據，以提升護理的照護品質。

關鍵字

結腸直腸癌；術後；早期進食

並列摘要

This article explores effects of early feeding post colorectal cancer resection of a 76-year-old woman. The subjective and objective data collected during the care between April 29 and May 9, 2015 using physical assessment, observation, consultation and Gordon 11 functional and health assessment tools. Nursing problem identified included anxiety, pain, nutritional imbalance and other related nursing problems. Initial interaction with empathic listening to encourage the patient to express her feelings and needs toward the surgery and provided pertinent disease and surgery related information and education. The care also assisted the patient to establish a support system that included other patients with similar experience. Postoperative teaching included drugs and non-drug pain management and adequate intake of nutrients to promote postoperative recovery. Upon discharge, the patient reported reduced anxiety, below 3 points pain score and no weight loss. Early feeding post colorectal surgery is a new approach that is not popular in current clinical practice that may lead to patients to experience doubt and anxiety. Pain may reduce the patient's willingness to comply. It is recommended to provide pre-op teaching with specific and complete reference in both written and video format to improve the clinical outcome.

並列關鍵字

colorectal cancer ； postoperative ； early feeding

參考文獻

Beck, D. E., Margolin, D. A., Babin, S. F., & Russo, C. T. (2015). Benefits of a multimodal regimen for postsurgical pain management in colorectal surgery. The Ochsner Journal, 15(4), 408-412. doi:10.1043/TOJ-15-0051

Harsoor, S. (2011). Emerging concepts in post-operative pain management. Indian Journal of Anaesthesia, 55(2), 101-103. doi:10.4103/0019-5049.79872

Joshi, G. P., Bonnet, F., Kehlet, H., & PROSPECT collaboration. (2013). Evidence-based postoperative pain management after laparoscopic colorectal surgery. Colorectal Disease, 15(2), 146-155. doi:10.1111/j.1463-1318.2012. 03062.x

Lau, C., Phillips, E., Bresee, C., & Fleshner, P. (2014). Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: A randomized controlled trial. Annals of surgery, 260(4), 641-647. doi:10.1097/SLA.0000000000000929

Zhuang, C. L., Ye, X. Z., Zhang, C. J., Dong, Q. T., Chen, B. C., & Yu, Z. (2013). Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: A meta-analysis of randomized clinical trials. Digestive Surgery, 30(3), 225-232. doi:10.1159/000353136

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照護一位接受結腸直腸癌切除術後早期進食之護理經驗

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