一位頸椎損傷併腸阻塞個案銜接長照2.0服務之照護經驗

Nursing Experience for a Case Having Cervical Spinal Cord Injury and Intestinal Obstruction and Receiving Long-Term Care 2.0 Service

10.6692/KJN.202004_37(1).0008

廖宜珊(Yi-Shan Liao)；鄭碧芬(Pi-Fen Cheng)；王姮樺(Heng-Hua Wang)；蘇郁婷(Yu-Ting Su)；陳繪竹(Hui-Zhu Chen)

長照2.0 ； 腸阻塞 ； 頸椎損傷 ； long-term care 2.0 ； intestinal obstruction ； cervical spinal cord injury

高雄護理雜誌

37卷1期（2020 / 04 / 01）

88 - 99

繁體中文

本文描述一位頸椎損傷併腸阻塞個案銜接長照2.0服務之照護經驗；個案因腸阻塞，接受剖腹探查及小腸切除術後入加護病房續照護。筆者於照護期間運用Gordon十一項健康功能型態進行整體性評估，確立個案有營養少於身體所需、組織完整性受損、家庭因應能力增進的準備度等健康問題。於照護過程中，會同營養師計算每日所需熱量，由腸道外提供營養，以維持個案住院時體重；同時利用個案手機錄製換藥過程作為輔助說明，以提升案妻換藥技能，並選擇合適的敷料促進傷口癒合，與醫療團隊及出院準備服務個管師擬定出院計畫及協助申請長照2.0服務，讓個案在返家後能即時運用國家政策的社會資源，除能有效減輕主要照顧者的負擔外，亦能讓個案出院後獲得持續性的照護。

The paper presents the nursing experience for a patient having cervical spinal cord injury and intestinal obstruction and receiving long-term care 2.0 service. Due to intestinal obstruction, the patient received both laparotomy and small bowel resection surgeries. Following these, the patient was transferred to the ICU to receive continuous care. During the caring period, the researcher used Gordon's 11 functional health patterns to make an overall evaluation of the patient, and then confirmed some health problems confronted by the patient such as insufficient nutrition, impaired tissue integrity, and increased readiness of the coping ability of the patient's family. In the caring process, the researcher and the dietitian calculated the daily calories required by the patient. We supplied nutrition from the outside of the intestine in order to maintain the weight of the patient during the hospitalization period. At the same time, the patient's wife was educated on changing dressing and choice of appropriate dressing for wound recovery by cellphone recording assistance. Suitable dressing materials were also selected to facilitate healing of the wound. The researcher collaborated with the medical team and discharge preparation service patient manager to draft a discharge plan for the patient, and helped the patient apply for long-term care 2.0 service, letting the patient immediately benefit from the social support of national policies after returning home. Not only could such service effectively reduce the burden on the primary caregiver, it could enable the patient to make immediate use of social resources, assuring them of continuous care.