照護一位結直腸癌術後併發周邊動脈阻塞之病人護理經驗

A Nursing Experience of Caring a Patient with Peripheral Arterial Occlusive Disease after Resection of Colorectal Cancer

10.6386/CGN.202012_31(4).0011

鄭棋芮(Chi-Jui Cheng)；柯幸芳(Hsing -Fang Ko)

紐曼理論 ； 結直腸癌 ； 周邊動脈血管阻塞 ； Neuman system model ； colorectal cancer ； peripheral arterial occlusive disease

長庚護理

31卷4期（2020 / 12 / 01）

582 - 592

繁體中文

本文為一位71歲女性，因解血便做大腸鏡發現結直腸癌第二期，接受腹腔鏡切除手術後併發周邊動脈阻塞，個案擔心出院後生活型態改變，產生難過哭泣、對未來沒有希望的情緒反應。護理期間自2018年10月30日至11月20日，運用紐曼理論進行評估分析其壓力源，並以觀察、會談等方式收集資料，確立主要健康問題有急性疼痛、周邊組織灌流失效、無望感。護理過程中，生理方面藉由換藥時音樂療法，指導家屬肌肉按摩及遠紅外線烤燈使用之緩解技巧，降低疼痛及促進末梢血液循環；心理方面教導個案調適，在壓力的環境產生防禦機制，進而使個案面對問題，改變負向看法，同時鼓勵家屬一同參與照護計畫並共同執行，重新建立個案治療的信心，讓個案順利的返家出院。

This article described the nursing experience of caring a 71-year-old woman, who was diagnosed with stage II colorectal cancer after receiving colorectal cancer screening for bloody stool. She suffered peripheral arterial occlusive disease due to a complication from laparoscopic surgery. The patient felt sad and hopeless because she was worried about the change of lifestyleafter being discharged from the hospital. During the nursing period from October 30 to November 20, 2018, the Neuman system model was applied to analyze the stressors and to collect data through observation, and interview. The nursing problems included acute pain, ineffective peripheral tissue perfusion, and hopelessness. During the nursing process, music therapy during dressing change, muscle massage by family members, and Far Infrared Heating Lamp were used to reduce pain and activate peripheral blood circulation. The patient was taught to adapt the change, to reduce the environmental stresses, to deal with her problems, and modify her negative behavior. Her family members were able to also join the nursing plan to enhance the patient's confidence and to help her to go back thome.

1. Anderson, J. L.,Halperin, J. L.,Albert, N.,Bozkurt, B.,Brindis, R. G.,Curtis, L. H.,DeMets, D.,Guyton, R. A.,Hochman, J. S.,Kovacs, R. J.,Ohman, E. M.,Pressler, S. J.,Sellke, F. W.,Shen, W. K(2013).Management of patients with peripheral artery disease（compilation of 2005 and 2011 ACCF/AHA guideline recommendations）: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Journal of the American College of Cardiology,61(14),1555-1570.
2. Britteon, P.,Cullum, N.,Sutton, M.(2017).Association between psych-ological health and wound complications after surgery.British Journal of Surgery,104(6),769-776.
3. Carli, F.,Silver, J. K.,Feldman, L. S.,McKee, A.,Gilman, S.,Gillis, C.,Bergdahl, C. S.,Gamsa, A.,Stout, N.,Hirsch, B.(2017).Surgical prehabilitation in patients with cancer: state of the science and recommendations for future research from a panel of subject matter experts.Physical Medicine and Rehabilitation Clinics,28(1),49-64.
4. Gabbard, G. O.(Ed.)(2009).Textbook of psychotherapeutic treatments.American Psychiatric Publishing, Inc..
5. Hida, K.,Hasegawa, S.,Kinjo, Y.,Yoshimura, K.,Inomata, M.,Ito, M.,Fukunaga, Y.,Kanazawa, A.,Idani, H.,Sakai, Y.,Watanabe, M.(2012).Open versus laparoscopic res-ection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study.Annals of surgery,255(5),929-934.
6. Neschis, D. G.,Golden, M. A.(2013).Up To DateUp To Date,未出版
7. Thiele, R. H.,Rea, K. M.,Turrentine, F. E.,Friel, C. M.,Hassinger, T. E.,Goudreau, B. J.,Umapathi, B. A.,LKron, I.,Sawyer, R.G.,Hedrick, T. L.,McMurry, T. L.(2015).Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery.Journal of the American College of Surgeons,220(4),430-443.
8. Waltham: Up To Date,Sand-Jecklin, K.,Emerson, H.(2010).The impact of a live therapeutic music intervention on patients' experience of pain, anxiety, and muscle tension.Holistic Nursing Practice,24(1),7-15.
9. 衛生福利部 (2018，6 月 15 日 )．106 年國人死因統計．取自 https://www.mohw.gov.tw/cp-16-48057-1.html [Ministry of Health and Welfare, Taiwan, ROC. (2018, June 15). 2017 Statistics of causes of death. Retrieved from https://www.mohw.gov.tw/cp-16-48057-1.html]
10. 鍾毓庭, Y. T.,鄭伯智, B. Z.(2014)。遠紅外線照射療法於周邊動脈阻塞疾病使用之成效。奇美醫訊，105，42-13。
11. 蘇清菁, C. C.,陳玉敏, Y. M.(2009)。無望感之概念分析。長庚護理，20(4)，456-462。