一位接受迴腸造口病患之護理經驗

A Nursing Care Experience for a Patient with an Ileostomy Secondary to Rectal Cancer

病患在接受腸造口手術時，往往會有很大的身心衝擊，且因直腸癌復發接受迴腸造口術之個案，更與一般接受結腸造口術不同，因此護理人員在面對個案及家屬時除需執行一般的身體照顧外，尚需對身體心像改變與其生活適應能力的減低及帶來的危機提供適當的護理。筆者是採用Roy's適應護理模式，於89年2月17日～89年3月13日進行觀察評估一位直腸癌的個案，深入探討個案在接受迴腸造口手術後，在生理功能、自我概念、角色功能與相互依賴等四個層面的改變，結果發現有生活適應困難的問題，如營養狀況改變、潛在危險性感染與身體心像紊亂等健康障礙。透過護理專業的介入，與個案建立良好的人際關係，積極處理生理及心理上的問題，以加強個案對生活上的適應能力；藉由理論與實務結合，提供預防與解決相關問題的方法，讓個案免於不必要傷害發生，使護理服務品質提昇，並在給予連續性、個別性、整體性的評估與照顧上，提出臨床護理經驗與大家分享，促使直腸癌病患享有高品質的生活。

When rectal cancer patients receive an ileostomy, they face tremendous physical and psychosocial impacts, especially those who have recurrent cancer. Therefore, nurses not only need to provide routine care for rectal patients with ileostomies, but also need to help patients adjust to changes in body image and adapt to life style changes. A rectal cancer patient with an ileostomy was observed from February 17, 2000 to March 13, 2000. Roy's Adaptation Model was used to assess the patient's changes in physiology, self-concept, role function, and interdependence. The results showed that the patient had alteration in nutrition, was at risk for potential infection, and had body image disturbance; all were related to adaptation difficulty. Strategies used to enhance the patient's living adaptability included building a good relationship with the patient and proactively managing the patient's physical and psychosocial problems. This case report used a theoretical model to help solve a patient's problems, prevent the patient from unnecessary injury, promote the quality of nursing care, and provide continuous, individualized, and comprehensive assessment and care. Such an approach can enhance the quality of life for other rectal cancer patients.