一位初次診斷結腸癌病患接受腹腔鏡手術之手術全期護理

Perioperative Nursing Experience on a Patient with Newly Diagnosed Colon Cancer Undergoing Laparoscopy

10.6647/CN.23.03.13

顏琇琳(Hsiu-Lin Yen)；鍾玉珠(Yu-Chu Chung)；陳佩英(Pei-Ying Chen)；宋佩芳(Pei-Fang Sung)

結腸癌 ； 手術全期護理 ； 焦慮 ； 疼痛

彰化護理

23卷3期（2016 / 09 / 01）

41 - 50

繁體中文

本文旨在探討一位初次診斷結腸癌個案接受腹腔鏡右半結腸切除術及腸吻合手術之手術全期護理經驗，護理期間自2014年6月5日至2014年6月14日，藉由觀察、會談、傾聽及身體評估方式進行有關病人生理、情緒、智能、社會、靈性的整體性評估，確立個案的主要護理問題包括：(一)手術前期：焦慮/缺乏手術、麻醉過程及術後照護相關之經驗；(二)手術中期：潛在危險性手術情境的傷害/全身麻醉、手術臥位；(三)手術後期：急性疼痛/腹部手術傷口及引流管。照護期間所採取之護理措施包括手術前提供與手術相關的訊息，增加個案對手術的認知，提供支持性護理減輕焦慮不安的情緒；手術中因個案採全身麻醉，給予完全代償性護理措施，預防因使用電燒器與截石臥位而造成的潛在危險性傷害；手術後在恢復室期間，以藥物及非藥物止痛措施，緩解個案的急性疼痛。出院後持續以電訪關懷，給予個案持續性的照顧，提升個案自我照顧能力，達到最佳健康狀況及恢復平常生活。

The purpose of this article was to explore nursing experience of a patient with newly diagnosed colon cancer and underwent laparoscopic right colon resection and anastomosis. Nursing care period was from June 5th to June 14th in 2014. Patient assessment data were collected through observation, interview, physical assessment and review of medical records, with focusing on the patient's physical, emotional, mental, social, and spiritual aspects. The major health problems of the patient included anxiety at the preoperative phase, potential hazards during the intraoperative phase, and acute pain in the postoperative phase. Nursing care interventions included providing useful messages and supportive care throughout preoperative phase to alleviate anxiety; giving full compensatory interventions to prevent the hazards during the intraoperative phase; providing non-pharmacological interventions and pharmacological treatments for reducing pain in postoperative phase; and continuing making phone calls to support the patient after discharging. All these helped the patient to enhance his self-care abilities and maintain his health status then got recover and returned to the usual life as before.

1. 孫瑞陽(2012)。音樂療法分析探討。美容科技學刊，9(3)，73-85。
   連結：
2. Association of periOperative Rigistered Nurse [AORN] (2013). Peri- operative RN. Retrieved from http://careercenter.aorn.org/jobs#/detail/5818987/6,false
3. Beckett, E.(2010).Are we doing enough to prevent patient injury caused by positioning for surgery?.Journal of Preoperative Practice,20(1),26-29.
4. Beyaz, S. G.,Bayar, F.,Erdem, A. F.(2011).Acute postoperative pain.Journal of Anesthesia and Clinical Research
5. Chiang, H. C.,Chen, W. T. L.,Wu, C.(2010).Laparoscopic-assisted versus open surgery for rectal cancer.Journal of Society of Colon and Rectal Surgeons,21(2),79-86.
6. Dragana, M.,Verica, M.,Miroslava, P.,Mirjana, M. C.,Tomislav, C.(2009).Assessment of quality of care in acute postoperative pain management.Vojnosanitetski Pregled,66(2),156-162.
7. Gupta, A.,Kaur, K.,Sharma, S.,Goyal, S.,Arora, S.,Murthy, R. S. R.(2010).Clinical aspects of acute post-operative pain management & its assessment.Journal of Advanced Pharmaceutical Technology & Research,1(2),97-108.
8. Kim, W. S.,Byeon, G. J.,Song, B. J.,Jeong, H.(2010).Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia.Korean Journal of Anesthesiology,58(4),328-333.
9. Millán, J. V.,Serrano, J. R. B.,Aguirre, J. M. O.(2010).Anxiety in preoperative anesthetic procedures.Cirugia y Cirujanos,78(2),147-151.
10. Patel, S.,Lutzl, J. M.,Panchagnula, U.,Bansal, S.(2012).Anesthesia and perioperative management of colorectal surgical patients-A clinical review ( Part1 ).Journal of Anaesthesiology Clinical Pharmacology,28(2),162-171.
11. Tanakal, N.,Ohnol, Y.,Horil, M.,Utadal, M.,Ito, K.,Suzuki, T.(2012).High preoperative anxiety level and the risk of intraoperative hypothermia.International Journal of Clinical Medicine,3,461-468.
12. 伍燕玲,吳秋燕,張玉珠,劉棻(2009).手術室護理.台北:華杏.
13. 任秀如(2012)。手術全期護理。醫療品質雜誌，6(3)，27-30。
14. 施佳玟,羅惠敏(2011)。手術中擺位傷害之護理。護理雜誌，58(5)，101-106。
15. 陳旺全(2010)。大腸癌之治療。北市中醫會刊，16(4)，5-17。
16. 歐吉性,余方榮,許文鴻,王聖雯,吳登強,胡晃嗚(2011)。大腸直腸癌的篩檢與監測及台灣施行現況。台灣醫界，55(3)，17-20。
17. 衛生福利部（2014）．衛生統計資訊網．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747

1. 蔡宜蓁、杜慧茹(2019)。一位結腸癌合併肝轉移病人之照護經驗。長庚護理，30(2)，217-228。