一位腦性麻痺術後併發短腸症病人之照護經驗

Nursing Experience of a Patient With Postoperative Cerebral Palsy and Short Bowel Syndrome

10.6142/VGHN.202309_40(3).0004

張文慈(Wun-Chi Jhang)；侯慧明(Hui-Ming Hou)

短腸症 ； 全靜脈營養 ； 居家呼吸器 ； 長照資源 ； short bowel ； total parenteral nutrition ； noninvasive ventilator ； long-term care resources

榮總護理

40卷3期（2023 / 09 / 01）

255 - 261

繁體中文;英文

本文描述一位腦性麻痺病人罹患肺炎及小腸膿瘍，手術後造成短腸症，教導主要照顧者居家照護並提供長期照護資源之護理經驗。護理期間於2021年4月23日至2021年6月1日，以觀察、病歷查閱、身體評估及會談等方法收集資料，運用Gordon十一項健康功能型態進行評估，確立護理健康問題為「低效性呼吸型態」、「營養狀況改變：少於身體所需」及「照顧者角色緊張」等。照護過程中指導案母執行胸腔物理治療、蒸氣吸入及抽痰維持呼吸道通暢；提供客製化模具、圖卡、機器說明書等，衛教使用居家呼吸器、腸造口及全靜脈營養相關照護；傾聽案母照護困境之想法，會診出院準備服務，協助申請長照2.0服務，讓病人出院後能順利銜接長期照護資源，降低案母返家照護之焦慮感，提升病人之照護品質。

This case study describes a nurse's experience of caring for a patient with cerebral palsy, pneumonia, small bowel abscess, and peritonitis who underwent surgery for removal of part of the small bowel, which caused short bowel syndrome; teaching a caregiver about home care; and providing community long-term care resources. During the nursing period from April 23 to June 1, 2021, data were collected through observation, medical record review, physical evaluation, and interviews. On the basis of Gordon's 11 Functional Health Patterns assessment, the primary problems identified were inefficient respiratory pattern change, nutritional status change (less than the body needs), and caregiver role stress. Chest physiotherapy, steam inhalation, and suction were provided to maintain airway patency during nursing care. Tailor-made molds, charts, and machine manuals were provided. Health education regarding home respirators, enterostomy, and total parenteral nutrition was also provided. The nurse listened to the thoughts of patient's mother about care problems, consulted the discharge preparation service, and assisted in the application for long-term care 2.0 services, enabling the patient to smoothly access long-term care resources after discharge, reducing anxiety of patient's mother regarding returning home for care, and improving the quality of care for the patient.

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