一位行腸造口手術後之護理經驗

The Nursing Experience of a Ileostoma Care

林霈蓉(Pei-Jung Lin)；劉嘉恩(Chia-En Liu)

歐倫自我照顧理論 ； 身體心像紊亂 ； 迴腸造口 ； Orem's self-care theory ； disturbed body image ； ileostomy

若瑟醫護雜誌

13卷1期（2019 / 06 / 01）

112 - 125

繁體中文

本文描述一位43歲男性正值壯年期罹患結腸癌，術後因腸吻合處滲漏，再次接受迴腸造口手術之護理經驗。護理期間自2015年6月10日至6月23日。筆者運用採會談、觀察、傾聽、陪伴等方式收集資料，並使用Orem自我照顧理論進行護理評估及擬定適切的護理措施。照護期間確立個案有急性疼痛、皮膟完整性受損、身體心像紊亂、焦慮等護理健康問題。護理過程中為了讓個案增強自我照顧能力，正確的認知及正向的調適，經由護理系統之完全代償性、部份代償性及支持教育性護理概念提供相關護理措施，除了與個案建立良好的護病關係，並運用非藥物方式有效減緩個案疼痛，指導並陪伴個案及家屬執行各項護理活動並使用腸造口護理手冊、圖片及造口模型進行衛教，提供完整正確資訊，加深學習成效，讓個案學習腸造口的自我照顧技巧，且成功地協助個案說出焦慮感受並面對疾病過程及身體外觀改變事實，協助個案勇於面對疾病帶來的衝擊，進而提升個案自我照顧及適應能力，恢復原有之生活品質。故藉此護理經驗與護理同仁分享，作為日後照顧此類病人的參考。

We describe a 43-year-old male patient who received right hemicolectomy due to colon cancer. Unfortunately, post-op anastomotic leakage noted and ileostomy was performed. Duration of the nursing care was between June 10 and 23, 2015. Interviewing, observation, listening, and companionship were used to collect information. The Orem self-care theory was applied for the evaluations and adequate procedures of nursing. The health care problems such as acute pain, impaired skin integrity, anxiety, and disturbed body image were established during the nursing care period. To enhance the self-care ability, correct cognition, and positive adjustment, the relevant nursing measurements were provided through the fully compensatory, partial compensatory, and supportive educational concept of the nursing system. In addition to establish a good relationship with the patient, we tried to relief his pain by the methods other than drugs. We accompanied the patient to execute the nursing activities and educated his families by using the enterostomy nursing manual, pictures, and stoma models. And that facilitate the self-care ability of his enterostomy. We also successfully help the patient to speak out his anxiety, to accept the progression of disease, and the changing of his body appearance. Thus the patient could face the impact of the disease, promote the ability of self-care and adaption, and restore his life quality. Here we share our experience for taking care of this kind of patients in the future.

1. Archie, P.,Bruera, E.,Cohen, L.(2013).Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature.Supportive Care in Cancer,21(9),2609-2624.
2. Deitz, D.,Gates, J.(2010).Basic ostomy management, part 1.Nursing,40(2),61-62.
3. Knowles, S. R.,Tribbick, D. C.,William, R.,Castle, D.,Salzberg, M. K.,Michael, A.(2014).Exploration of health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients.Journal of Wound, Ostomy & Continence Nursing,41(6),573-580.
4. Park, J. S.,Choi, G.-S.,Kim, S. H.,Kim, H. R.,Kim, N. K.,Lee, K. Y.,Kim, B C.(2013).Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group.Annals of surgery,257(4),665-671.
5. Perston, Y.(2010).Ensuring effective technique in colostomy irrigation to improve quality of life.gastrointestinal nursing,8(4),18-22.
6. Prinz, A.,Colwell, J. C.,Cross, H. H.,Mantel, J.,Perkins, J.,Walker, C. A.(2015).Discharge planning for a patient with a new ostomy: best practice for clinicians.Journal of Wound Ostomy & Continence Nursing,42(1),79-82.
7. Sheila, S. R.,Cynthia, M. T.,黃靜微（譯）,林家綾（譯）,喬佳宜（譯）,程子芸（譯）,林麗秋（譯）,郭惠敏（譯）,張秉宜（譯）(2014).最新護理診斷手冊,護理計畫與措施.台北:華杏出版公司.
8. Walid, M. S.,Donahue, S. N.,Darmohray, D. M.,Hyer, L. A., Jr,Robinson, J. S., Jr(2008).The fifth vital sign- What does it mean?.Pain Practice,8(6),417-422.
9. 王蔚芸,王桂芸,湯玉英(2007)。焦慮之概念分析。長庚護理，18(1)，59-67。
10. 李秀枝,吳聖良(2010)。病人主訴術後疼痛強度與護理人員評估結果差異之比較。護理雜誌，57(3)，60-68。
11. 杜友蘭(2003).護理理論與實務應用.台北:華杏出版公司.
12. 車先蕙,盧孟良,陳錫中,張尚文,李宇宙(2006)。中文版貝克焦慮量表之信效度。臺灣醫學，10(4)，447-454。
13. 明金蓮,洪曉佩(2011)。急性疼痛評估與症狀護理。源遠護理，5(1)，11-16。
14. 徐完雲,陳筱瑀(2008)。焦慮的概念分析。志為護理，7(3)，65-70。
15. 張瓈方,張乃文,王桂芸(2010)。身體心像紊亂之概念分析。長庚護理，21(1)，25-32。
16. 曾淑榆,謝雅婷,王晶瑩,林秀如,沈永釗,簡麗瑜(2013)。提昇護理人員對術後腸造口照護之完整性。長庚科技學刊，19，137-149。
17. 黃家麗,唐秀燕(2011)。一位腸造口術後患者面對身體心像紊亂之護理經驗。嘉基護理，11(2)，47-57。
18. 楊濱輔(2015)。淺談大腸直腸癌手術治療。高醫醫訊，34(12)，9。
19. 詹淑雅,劉芹芳,金繼春(2011)。身體心像紊亂之概念分析。新臺北護理期刊，13(1)，63-72。
20. 劉雪娥（校閱）(2014).成人內外科護理.台北:華杏出版公司.
21. 蔡秀香,李俞弘,楊燿擎(2005)。協助一位永久性腸造口患者自我照顧之護理經驗。慈濟護理雜誌，4(4)，97-106。
22. 衛生福利部：106年死因統計結果分析。2017。取自 http://www.mohw.gov.tw/cht/DOS/St atistic.aspx?f_list_no=312&fod_list_ no=5488
23. 蘇佳薇,林祝君(2011)。運用 Orem理論照護潰傷性結腸炎患者接受迴腸造口之護理經驗。長庚護理，22(2)，238-247。

1. 江秋萍(2022)。卵巢癌併發結腸與膀胱間瘻管病人接受腸造口手術之護理經驗。新臺北護理期刊，24(1)，129-137。