照護一位罹患馬蹄腎青少女接受全腎切除手術之護理經驗

Nursing Experience of a Teenage Girl of Horseshoe Kidney undergoing Total Nephrectomy

10.6647/CN.201812_25(4).0011

戴淑芬(Dai, Shu-Fen)；林心怡(Lin, Hsin-Yi)

馬蹄腎 ； 全腎切除 ； 青少女 ； horseshoe kidney ； radical nephrectomy ； teenage girl

彰化護理

25卷4期（2018 / 12 / 01）

84 - 97

繁體中文

本文在探討照顧一位14歲青春期少女，因罹患右側馬蹄腎合併萎縮接受全腎切除手術之護理經驗。照護期間自2016年6月30日至2016年7月9日，運用Gordon十一項功能性健康評估指引，藉由觀察、會談、傾聽及身體評估等方式收集資料，確立三項健康問題為焦慮、急性疼痛、身體心像紊亂等。護理過程中結合其他醫療團隊人員舉辦病情說明會，透過平板電腦及手術圖像方式詳細說明手術過程，有效降低青春期發展中失去控制力之住院焦慮反應；另主動給予個案適時關懷及鼓勵、順利與個案建立良好的護病關係，藉由個案喜愛的音樂、舒適姿勢擺位及深呼吸等護理措施來緩解疼痛；又因個案正值青春期面對突如其來的重大手術造成生理、心理極大的壓力，擔心手術後身體外觀的改變以及預後情況，予以引導說出、傾聽及接納態度、多給予正向鼓勵及透過同儕力量來幫助個案抒發情緒壓力，進而得到良好適應行為。個案在經過妥善手術治療及護理措施後，勇敢克服疾病帶來的衝擊，順利出院返家。冀望藉此護理經驗來提升自我工作能力，並期待能做為日後護理同仁照護此類病人之臨床參考。

This article is to describe the nursing care experience for a 14 year-old teenage girl who underwent radical right nephrectomy due to horseshoe kidney complicated with renal atrophy. The period of nursing care was from June 30th to July 9th 2016. The authors collected data through observation, interview, listening, physical examination, and analysis with Gordon's Functional Health Patterns. The result showed that the patient's health problems are as follows: anxiety, acute pain and disturbed body image. The authors collaborated with other allied health professions to hold illness explanation events during the nursing care period. Through using I-Pad and surgical images to explain surgical procedure, the developing adolescence's anxiety from the sense of losing control in the hospital was effectively reduced; well bounded patient-nurse relationship was established when gentle care and encouragement were provided. By listening the patient's favorite music, comfortable positioning and deep breathing techniques, acute pain was relieved; nevertheless, due to patient's age, facing such a major operation not only caused psychological but also physical stress. Patient worried about her body image change post operatively and subsequent prognosis, thus the authors guided and assisted patient to talk and relieve stress with techniques of listening, showing acceptance, giving positive encouragement and power from peers to gain well acclimated behavior. Patient went home after receiving great surgical treatment and holistic nursing implementation; she has overcome the disease impact with courage. Finally, the authors hope this article can build a good practice for later caregiver to improve their learning experience.

1. 陳美菊,龔秀華,湯玉珊,簡麗瑜(2016)。改善骨科手術前病人焦慮程度之專案。長庚護理，27(2)，97-208。
   連結：
2. 黃惠卿,蔡曉薇,湯婉孏(2016)。一位因車禍導致壞死性筋膜炎青少女之加護經驗。志為護理，15(2)，89-98。
   連結：
3. Castarlenas, E.,Sanchez-Rodriguez, E.,Vega Rde, L.,Roset, R.,Miro, J.(2015).Agreement between verbal and electronic versions of the numerical rating scale (NRS-11) when used to assess pain intensity in adolescents.Clinical Journal of Pain,31(3),229-234.
4. Irshad, A. (2015, Oct 28). Horseshoe Kidney Imaging. Retrieved from http://emedicine.medscape.com/article/378396-overview#a1
5. MedlinePlus. (2015, June 29). Kidney removal - discharge. Retrieved from https://medlineplus.gov/ency/patientinstructions/000295.htm
6. Natsis, K.,Piagkou, M.,Skotsimara, A.,Protogerou, V.,Tsitouridis, I.,Skandalakis, P.(2014).Horseshoe kidney: a review of anatomy and pathology.Surgical and Radiologic Anatomy,36(6),517-526.
7. Nefrolitotomi, A. N. B. P.,Deneyimimiz(2015).Percutaneous Nephrolithotomy in Horseshoe Kidney: Our First Experience.Journal of Urological Surgery,1,17-21.
8. Rad, M. P.,Ahmadnia, H.,Abedi, M.,Abedi, M. S.,Gui-e, L.(2012).Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horse-shoe kidney.Chinese Journal of Traumatology,15(2),118-120.
9. The Ottawa Hospital. (2013). Minimally Invasive Surgery (MIS) and Open Nephrectomy(Partial, Radical and Donor). Retrieved from https://www.ottawahospital.on.ca/en/documents/2017/01/minimally-invasive-surgery-mis-and-open-nephrectomy.pdf
10. 吳佳慧(2014)。樹德科技大學人類性學研究所。
11. 陳月枝（校閱）(2014).實用兒科護理.台北:華杏.
12. 陳亞欣,顧雅利,董曉婷(2012)。青少年初次罹患自發性氣胸接受胸腔鏡肺楔狀切除術之護理經驗。高雄護理，29(3)，29-39。
13. 陳姝娟,林美蓮(2013)。照護一位腿部創傷併發急性腔室症候群個案之護理經驗。志為護理，12(2)，102-111。