照護一位早產兒合併腹裂畸型術後之護理經驗

Nursing Experience from Caring for a Premature Infant with Gastroschisis

10.29494/LN.202009_21(3).0006

莊佳霖(Jia-Lin Jhuang)；吳麗月(Li-Yue Wu)；張惠晴(Hui-Ching Chang)

早產兒 ； 腹裂畸形 ； 發展支持性照護 ； premature infant ； gastroschisis ； development supportive care

領導護理

21卷3期（2020 / 09 / 01）

60 - 74

繁體中文

本文是描述一位33^(+5)週的早產兒合併腹裂畸形行分期腹壁閉合術後的照護過程，護理期間於2017年11月3日至11月29日，運用系統性身體評估、直接參與照護、參考病歷、同時做家庭評估、會談、觀察與記錄個案之疾病進展與行為發展等資料，確立組織灌流失效／腸胃、急性疼痛、照顧者角色緊張等三項健康問題，照護過程中運用發展支持性照護的寧握護理、築巢擺位、袋鼠式護理及觸覺刺激，使其減輕疼痛，並穩定生命徵象變化，照顧者方面，透過病情的說明、鼓勵父母親進行袋鼠式護理，建立親子依附關係，減輕焦慮，彈性安排會客、跟雙親共同討論安排相關照顧認知及技巧等回覆示教，適時給予鼓勵，提升照顧技能及增加自信心，讓個案得到良好的照護。

This article describes the care process of a 33+5 week premature infant with gastroschisis after staged abdominal wall closure. The nursing period is from November 3rd to 29th in 2017, with data obtained from systemic physical examination, direct nursing care, referring medical record, family background, interviewing, observation and records of the disease progression as well as behavioral development of individual cases. We established three health issues: failure of gastrointestinal tract; gastrointestinal tract; acute pain, and stress of the care givers. Applying development support in the care process includes containment, positioning, Kangaroo care, and stimulation by touching can reduce pain and stabilize the changes in vital signs. For the care givers, we carefully explained the symptoms, demonstrated the Kangaroo care, and establish the way to parent-child attachment relationships. As for the reduction of anxieties, we arrange the flexibility of visiting, discuss with parents to arrange relevant care cognition, skill and so on; reply teaching, provide timely encouragement, enhance care skills and increase self-confidence, so the case project is well looked after.

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