照顧一位直腸癌患者之護理經驗

A Case Study of Rectal Cancer Nursing Care

曾筱惠(Hsiao-Hui Tseng)

《長庚科技學刊》 15期 (2011/12) Pp. 81-90

https://doi.org/10.6192/CGUST.2011.12.15.6

摘要

本文描述一位直腸癌（Rectal cancer）個案，因腫瘤突出肛門，嚴重影響日常生活、排泄及營養，故入院接受腸造口手術及化學治療之護理經驗。於2007年6月8日至2007年7月5日護理期間，以會談、觀察及運用Gordon十一項功能性健康型態評估，依生理、心理、社會方面分析，確立個案有疼痛、自我照顧能力缺失、身體心像紊亂等護理問題。運用家屬的支持及醫療團隊的合作，以轉移注意力減輕疼痛不適，訓練個案及家屬處理腸造口及相關問題，介紹類似個案成功經驗降低焦慮與適應身體心像改變，使個案疼痛與焦慮緩解，進而增加自信心，出院時已能接受造口為自己身體的一部份，並學習到永久性腸造口的照護方式，養成固定排使習慣。返家一個月後，個案表達對腸造口居家自我照顧和適應能力良好。透過此護理經驗，期望能讓腸造口護理更具專業性及系統性，並落實於護理臨床，使護理人員對此技術有正確的認真口，進而應用於照護服務對象中。

關鍵字

直腸癌 ； 腸造口

並列摘要

This article describes the nursing experience of taking care of a patient who was diagnosed with rectal cancer and received colostomy surgery and chemotherapy due to suffering from a tumor protruding out of the anus. This symptom seriously affected the patient’s daily life and led to poor defecation and nutrition. The methods of data collection included observation, face-to-face interviews, and physical assessments based on Gordon’s 11 functional health patterns. The patient’s health problems included anxiety, pain, and body-and-mind image disturbance.Working closely with the patient’s family and medical teams, we provided the patient’s family with the necessary training to deal with the colostomy, to cope with the related problems, and to distract the patient when necessary in order to alleviate the patient’s pain and discomfort.We were able to successfully alleviate much of the patient’s anxiety and physical- and mentalimage disturbance and help the patient to accept the colostomy as part of his body. We also taught him how to take care of the colostomy and to defecate regularly. One month after the patient had returned home, the patient continued to demonstrate good adaptation and self-care techniques. It is hoped that this account of successful nursing care for a permanent colostomy can be used as an example for other nurses wishing to provide knowledgeable, professional, and effective nursing care for patients under similar circumstances.

並列關鍵字

rectal cancer ； colostomy