照顧一位接受機器人手臂行攝護腺切除手術病人之術後照護經驗

Nursing Care Experience of a Patient with Robotic-Assisted Laparoscopic Radical Prostatectomy

黃嘉安(Jia-An Huang) ； 張景鳳(Ching-Feng Chang) ； 黃嗣棻(Szu-Fen Hung)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 88-99

https://doi.org/10.6740/NTUHJN.201901_15(1).0009

摘要

本文描述照顧一位行機器人手臂切除攝護腺手術病人之護理經驗，術後因傷口痛、腹脹及膀胱尿道吻合處傷口癒合不佳導致尿液滲漏，出院時需留置尿管及引流管返家，故而無法達到個案對手術預期的結果，因而產生極大的焦慮與壓力。護理期間為2016年6月19日至7月14日，運用Gordon 11項功能性健康型態進行整體性評估，經由查閱病歷、觀察、會談及身體評估等方式完成資料收集，確立健康問題有急性疼痛、營養少於身體需要及個人因應能力失調等。針對個案提供個別性照護，對於手術前後的焦慮，提供衛教及心理支持，以降低其焦慮；術後予緩解疼痛的措施及適當的飲食衛教，增進其舒適程度與營養狀況；予以出院照護相關衛教及指導，提升自我照顧能力以增進生活品質與因應能力。此護理經驗中建議照護此類病人時，應同時著重生理與心理之照護，可減輕因疾病認知不足及傷口癒合不良所產生的生理、心理衝擊，以協助正向的疾病適應，與恢復預期的健康狀況。希望藉此篇護理經驗分享，提供日後照護之護理參考。

關鍵字

攝護腺癌 ； 機器人手臂 ； 急性疼痛

並列摘要

This article described the case who had underwent robotic-assisted laparoscopic radical prostatectomy suffered from wound pain, bloated and urine leakage caused by poor healing on the bladder neck and urethral anastomosis. Therefore, the case needed to be discharged with foley catheter and drainage tube. Because the treatment did not meet his expectations, produced great anxiety and stress. During the nursing case period from June 19^(th) to July 14^(th), 2016, we performed assessment with Gordon's 11 functional health patterns assessment tool. Data were collected through medical records review, observation, interview, and physical assessments. The three major identified health problems were acute pain, nutrition imbalanced less than body requirements, and ineffective individual coping strategy. We provided individualized nursing care interventions, health education, and psychological support pre- and postoperatively in order to reduce his anxiety. Furthermore, appropriate pain control and dietary education were offered after surgery for improving the comfort and nutrition. We also provided related teaching and nursing care education, enhanced his self-care ability to promote the quality of life and coping strategy. It is recommended that the care of patients should focus on physical and psychological care at the same, and this will reduce psychological impact, improve disease adaptation, return to healthy status. We offered this care experience for reference.

並列關鍵字

prostate cancer ； robotic-assisted laparoscopic radical prostatectomy ； acute pain