一位卵巢癌併發腸阻塞接受腸造口手術病人之護理經驗

Post-Enterostomy Nursing Care for an Ovarian Cancer Patient with Intestinal Obstruction Complication

10.6880/TJON.202012_20(2).06

李翊鈴(Yi-Ling Li)；劉淑倩(Shu-Chien Liu)；王美文(Mei-Wen Wang)

卵巢癌 ； 腸阻塞 ； 腸造口 ； 護理經驗 ； Ovarian cancer ； intestinal obstruction ； enterostomy ； nursing experience

腫瘤護理雜誌

20卷2期（2020 / 12 / 01）

47 - 58

繁體中文

本文係探討一位卵巢癌併發腸阻塞接受腸造口手術病人之護理經驗。此個案為卵巢癌術後復發引發小腸阻塞，因腹部脹痛及頻繁嘔吐導致身體的嚴重不適，經告知腫瘤復發需手術切除部分小腸並行迴腸造口術，對於疾病治療感到消極，因此引發筆者之動機，期望藉由傾聽、主動關懷等護理措施，協助個案了解並接受自己的疾病狀況，筆者由2018年4月18日至5月10日照護期間，藉由與個案訪談、觀察、病歷收集、數字疼痛評估量表及以Gordon十一項健康功能評估進行整體性護理評估，確立主要健康問題：急性疼痛、無望感及知識缺失。藉由傾聽、主動關懷等護理措施，協助個案了解並接受自己的疾病狀況，並請醫療團隊針對個案治療過程疑慮加以解釋及澄清，使個案降低無望感。手術後評估個案疼痛指數，適時使用止痛藥物協助緩解術後疼痛，另提供腸造口衛教單張、造口辨識卡及造口評估量表協助個案了解腸造口正確自我照護方式。建議可定期安排造口護理師針對次專科病房人員進行在職教育課程，提供相關案例共同討論並規劃各專科病房輪訓計劃，來增進其他專科特有疾病相關新知，促進學術交流及護理照護，以提升病人照護品質。

This article is to discuss the nursing experience of an ovarian cancer patient who underwent enterostomy for intestinal obstruction complication. This patient had a small intestinal obstruction caused by recurrence of ovarian cancer. It was associated with abdominal distension and frequent vomiting. When told of the recurrence of ovarian cancer requiring surgical excision of part of the small intestine and ileostomy, the patient felt negative and pessimistic about the treatment, which was what motivated the author. Author hoped that by listening, compassion and other nursing measures, she can make the patient understand and accept her disease and treatment. During the period of care from April 18 to May 10, 2018, the author identified the main health problems: acute pain, hopelessness and lack of knowledge through interviews, observation, medical records collection, digital pain assessment scale, and holistic nursing assessment with Gordon 11 Functional Health Pattern. Good listening skills, compassionate caring, and other nursing measures can help the patients understand and accept their disease status. The intervention of the medical team who explained and cleared the doubts about the treatment process also helped to reduce the sense of hopelessness in the patient. After the operation, family members were encouraged to provide support, pain levels were monitored, pain relief drugs were used in time to help alleviate the pain. A health education leaflet for enterostomy, a stoma identification card and a stoma evaluation scale were also provided to help the patients understand the correct self-care method for enterostomy. It is suggested that on-the-job education courses should be arranged regularly by stoma nurses for the staff in the sub-specialty wards, relevant cases should be discussed together, and rotation training plans for each specialty ward should be planned for the purpose of gaining the new knowledge of other specialty-specific diseases and promoting academic exchanges on nursing care for the betterment of the quality of patient care.

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