一位糖尿病合併膀胱癌患者之術後迴腸膀胱造瘻照護經驗

Nursing experience of assisting a diabetic patient with bladder cancer in self-care of ileal conduit

蔡姿伶(Tzu-Ling Tsai)；魏惟琪(Wei-Chi Wei)；馬秀玲(Shu-Ling Ma)；何幸美(Hsin-Mei Ho)

膀胱癌 ； 迴腸膀胱造瘻 ； 糖尿病 ； 疼痛 ； 穴位按摩 ； 跨領域團隊合作照護 ； bladder cancer ； ileal conduit ； diabetes ； pain ； acupoint massage ； inter-Professional Practice

安泰醫護雜誌

30卷1期（2024 / 06 / 01）

85 - 99

繁體中文;英文

本文探討一位65歲女性診斷為膀胱癌第四期，合併肺、子宮及左側髂淋巴結轉移，有糖尿病病史，此次接受根除性膀胱切除併骨盆淋巴、子宮及卵巢摘除手術之照護經驗。護理期間為2018年6月3日至7月1日，筆者以會談、觀察、臨床評估及病歷查閱等方式收集資料，運用Gordon十一項健康功能型態評估方法進行整體性評估，確立個案有疼痛、血糖不穩定等健康問題，術後有迴腸膀胱造瘻留置，個案需學習其相關照護技巧。護理期間，筆者運用專業知識、多元化衛教及跨團隊共同照護模式，依個案獨特需求，提供個別性措施，如穴位按摩、錄製影片、飲食計畫及提供造瘻模型道具…等，使個案疼痛緩解及血糖獲得良好控制，成功學習居家相關照護技能，進而建立其自信心，使居家生活品質提升。

This article explores a nursing experience of caring a 65-year-old female patient received radical cystectomy with pelvic lymph node, uterus and ovary removal. The patient had medical history of diabetes. She was diagnosed stage 4 bladder cancer with lung, uterus and left iliac lymph node metastases. Nursing care was provided from June 3 to July 1 of 2018. The author collected information by interviews, observation, clinical evaluation and medical record review, followed with comprehensive assessment by the Gordon's 11 functional health patterns, and established the health issues of pain, unstable blood sugar level in this case. After the aforementioned removal surgery, the patient had ileal conduit and needed to learn the relevant nursing skills for self caring. During nursing period, the author used professional knowledge, diversified health education methods and a cross-team co-nursing model to provide individualized nursing care, such as acupoints massage, video recording, personalized meal plan, and education with ileal conduit anatomy model… etc. This case had relieved pain and well controlled blood sugar finally. She acquired related home nursing skills, built self-confidence successfully, and ameliorated quality of household life.