照護一位結腸癌手術病患之手術全期護理經驗

本文係探討一位老年婦女因腸阻塞急行腸造緩解阻塞情形，經病理檢查確定為結腸癌而需再次接受手術，個案面對罹患癌症及再次腸道手術的不確定感仍顯焦慮不安。筆者於2007年5月9日至20日期間，運用Orem理論為評估工具及手術全期護理為架構，透過身體評估、觀察、傾聽、會談等技巧收集資料，照護過程中發現個案的健康問題有「手術前期：焦慮」、「手術中期：潛在危險性手術情境的傷害／手術中擺位－截石臥位」、「術後：疼痛／術後傷口」等。整體照護過程中針對個案的需求提供支持性及手術、癌症相關教育訊息，減輕個案焦慮；手術中期提供完全代償性護理保護病人安全，給予個案神經肌肉關節及避免皮膚受損的完整保護；術後提供部分代償性護理，緩解個案疼痛情形鼓勵早期下床活動，進而提升個案自我照顧能力。期望藉由應用手術全期護理，協助個案處理健康問題，提升護理服務品質，使個案獲得連續性及整體性照護。
This case report describes the perioperative nursing experience caring for a patient who had bilateral total hip and knee replacement. While undergoing a colonostomy, the patient was found pathologically to have colon cancer. The patient, experiencing great anxiety, underwent several operations. Between 2006/7/19 to 2006/7/24, we used Orem self-care patterns as a theoretical basis for assessing the patient's physical, mental, and social health problems. Preoperatively, the patient's most important health problem was anxiety, intraoperatively risk of Injury and infection, and postoperatively phase-pain. During the preoperative period, nursing care involved empathetic listening and teaching the patient how to dress a wound to help the patient effectively face the challenges of surgery. This approach helped decrease preoperative anxiety in the patient and helped him gain more confidence.