一位高齡直腸癌術後復原遲緩個案之照護經驗

Caring for an Elderly Patient of Prolonged Postoperative Recovery after Rectal Cancer Surgery

10.6880/TJON.202110/SP_21.05

林妤純(Yu-Chun Lin)；陳繪竹(Hui-Zhu Chen)；王姮樺(Heng-Hua Wang)；陳遴鞠(Lin-Jiu Chen)

高齡 ； 直腸癌 ； 術後復原遲緩 ； elderly ； rectal cancer ； prolonged postoperative recovery

腫瘤護理雜誌

21卷增訂刊I（2021 / 10 / 01）

49 - 60

繁體中文

本文為一位高齡老人行腹腔鏡腹部會陰聯合切除併永久性結腸造口手術，術後疑似延遲性小腸破裂，緊急行腹腔鏡小腸修補手術之照護經驗，護理期間為2018年10月10日至11月01日，運用Gordon十一項功能性健康評估工具，經會談、身體評估、查閱病歷及直接護理收集資料，確認個案有急性疼痛、術後復原遲緩及照顧者角色緊張的健康問題。照護過程中，依醫囑給予止痛藥物，使用雙層加壓束腹帶固定腹部傷口、運用蜂巢矽膠坐墊降低會陰傷口疼痛感，透過穴位按摩及加強肌力復健運動，協助個案下床活動以增加腸蠕動，緩解腹脹感，照顧者隨著個案出院日的來臨而感壓力倍增，以陪伴及傾聽並引導說出感受，提供疾病照護資訊，運用傷造口照護模型以熟練返家照護技巧，以降低焦慮感，且和家屬們共同討論返家之分攤照顧，能適時紓解照顧者之壓力。

This article discusses the experience of caring for an elderly individual that underwent emergency laparoscopic small bowel repair from a possible delayed intestinal rupture after a laparoscopic abdominoperineal resection and permanent colostomy surgery. The nursing care period was from October 10, 2018 to November 1, 2018. The Gordon's eleven functional health patterns assessment tool was used to collect data through discussions, physical assessments, consulting medical records, and direct care. It is confirmed that the patient had the health problems of acute pain, prolonged postoperative recovery, and caregiver role strain. During the nursing care process, in accordance with the doctor's advice, analgesics were given, double-layer compression wrap was used to stabilize abdominal wounds, honeycomb silicone seat cushions was used to reduce perineal wound pain, acupuncture massage and muscle-strength rehabilitation exercises were used to assist the patient to get out of bed to improve bowel movements and also to relieve the abdominal distention. The female caregiver, feeling increased pressure as the discharge day neared, was encouraged to express the feelings through companionship and listening while the patient care information was provided. Using the wound and ostomy care model to gain proficiency in home care skills can reduce anxiety, and having discussion with family members on sharing the caregiving responsibilities can timely alleviate the pressure of caregivers.

1. Gero, D.,Gié, O.,Hübner, M.,Demartines, N.,Hahnloser, D.(2017).Postoperative ileus: In search of an international consensus on defi nition, diagnosis, and treatment.Langenbeck’s Archives of Surgery,402(1),149-158.
2. Gregory, J.(2019).Use of pain scales and observational pain assessment tools in hospital settings.Nursing standard,34(9),70-74.
3. Hsiung, W. T.,Chang, Y. C.,Yeh, M. L.,Chang, Y. H.(2015).Acupressure improves the postoperative comfort of gastric cancer patients: A randomised controlled trial.Complementary Therapies in Medicine,23(3),339-346.
4. Kirkland-Kyhn, H.,Martin, S.,Zaratkiewicz, S.,Whitmore, M.,Young, H. M.(2018).Ostomy care at home.The American Journal of Nursing,118(4),63-68.
5. Lin, N. L.,Wang, H. S.,Jiang, J. K.,Lin, H. H.,Lin, C. C.,Lan, Y. T.,Chang, S. C.,Yang, S. H.,Chen, W. S.,Lin, T. C.,Lin, J. K.(2018).The surgical outcome of tumor resection surgery for octogenarian patients with colorectal cancer.The Journal of Society of Colon and Rectal Surgeons,29(1),22-28.
6. Romanzini, A. E.,Carvalho, E. C.,Galvão, C. M.(2015).Delayed surgical recovery: a concept analysis.Revista Brasileira de Enfermagem,68(5),668-675.
7. Vilz, T. O.,Stoffels, B.,Strassburg, C.,Schild, H. H.,Kalff, J. C.(2017).Ileus in adults.Deutsches Ärzteblatt International,114(29-30),508-518.
8. 于博芮（校閱）(2017).最新傷口護理學.華杏.
9. 王桂芸（校閱）,劉雪娥（校閱）,馮容芬（校閱）(2017).新編內外科護理學上冊.永大.
10. 林麗嬋(2018).老年護理學.華杏.
11. 陳強儀,周曉禎,卜宜芝,余明錚,徐濬婕,蔡慧玲,樹金忠,陳晉興(2015)。周全性老年評估個案報告：腹部手術及併發症後的功能衰退。台灣老年醫學暨老年學雜誌，10(1)，42-53。
12. 衛生福利部（2019，6月21日）．民國107年主要死因結果統計分析．http://dep.mohw.gov.tw/DOS/1p-4472-113.html