一位膀胱癌病患接受迴腸膀胱造口術之護理經驗

Nursing Experience of a Bladder Cancer Patient Undergoing Ileal Bladder Conduit Surgery

10.6692/KJN.202112_38(3).0010

李捷凱(Chieh-Kai Lee)；蔡富卿(Fu-Ching Tsai)；賴美玉(Mei-Yu Lai)

膀胱癌 ； 膀胱造口 ； 身體心像紊亂 ； Bladder Cancer ； Ileal Bladder Conduit Surgery ； Body Image Disturbance

高雄護理雜誌

38卷3期（2021 / 12 / 01）

111 - 123

繁體中文

本文探討一位病患因膀胱癌復發接受膀胱全切除及迴腸膀胱造口手術後之護理經驗。筆者於2018年3月17日至4月10日止，照護期間運用Gordon十一項功能性健康型態評估工具，經由身體評估、病歷查閱、術後照護、觀察及會談等方法收集資料，確立病患有急性疼痛、皮膚完整性受損及身體心像紊亂之護理問題。照顧期間運用傾聽、同理心與病患建立良好護病關係，藉由個別性護理措施，教導運用音樂療法分散病患注意力及透過肢體按摩輔助，並配合止痛藥物以減緩急性疼痛；衛教病患攝取高蛋白飲食、術後傷口照護、迴腸膀胱造口照護，並定期追蹤檢驗感染數值，以改善皮膚完整性受損問題；護理過程與家屬共同擬定照護計劃提供情緒支持與照護資訊，鼓勵病患主動學習相關照顧知識，以減少病患術後出現心理情緒障礙情形。另外，建議運用醫療團隊力量，在病患術前即提供造口相關資訊及提供類似案例分享，以協助病患儘早接受及正視身體心像改變的事實。

This article intends to explore the nursing experience of caring for a recurrent bladder cancer patient undergoing total cystectomy and ileal conduit surgery. During the period of March 17 to April 20 2018, according to the Gordon 11 item Functional Assessment of Health, data was collected through methods such as physical assessment, medical record review, post-operative care, observation and interviews. The nursing diagnosis was then classified as acute pain, impaired skin integrity and disturbed body image. During the care period, listening and empathy was used to establish a good relationship with the patient, and through individual care measures, teaching use of music therapy to distract the patient's attention, assisting in physical massage, and administering pain medication to relieve acute pain was carried out while concurrently guiding the patient to take a high-protein diet, attend to wound care, ileal conduit care and regularly check infection index to improve impaired skin integrity. Next, a care plan was developed with family members to provide emotional support and care information, encourage the patient to actively learn relevant care knowledge, and reduce the patient's apparent psychological disorder. Additionally, medical teamwork was recommended to provide information on ileal conduit and similar case sharing before the patient was readied for surgery. Finally, empathy was used to assist the patient in accepting and facing up to the fact that the body is inevitably changing under such conditions as encountered here.

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