一位臍尿管癌復發且合併腸阻塞患者之護理經驗

A Nursing Experience of an Urachal Cancer Recurrence-related Bowel Obstruction Patient

本篇個案報告為探討一位罹患臍尿管癌且合併多處轉移的男性患者，因臍尿管癌復發造成腸阻塞而持續承受噁心嘔吐的困擾及面對疾病未知治療的擔心。故於護理期間以Gordon十一項功能性健康型態之評估作為指引，經由與個案或家屬互動過程中，利用觀察、訪談的方式收集資料，歸納個案的護理問題包含：手術前是否要接受腸造口手術的決策過程，以及手術後傷口疼痛及腸造口所造成身體心像改變的問題。因此護理過程運用傾聽與同理心給予個案及家屬正面支持，提供腸造口相關資料與諮詢且分享國內外臍尿管癌手術成功案例，讓個案及家屬對腸造口能進一步認識以增加對手術的信心，減少擔心手術後照顧之焦慮，進而願意接受手術治療的決策過程，並於手術後提供相關之護理措施，減輕手術後傷口疼痛及協助解決腸造口所造成身體心像改變的問題。期望藉此護理經驗，作為往後護理此類患者身心方面之參考，以提供更適切性護理。

This case report described the nursing experiences of a male patient with urachal cancer combined with multiple metastases. Due to cancer recurrence-related bowel obstruction, the patient suffered from nausea and vomits and mentally, he experienced anxiety resulting from concerns about subsequent treatments. We used the Gordon’s functional health patterns as a guidance to communicate with the patient and his family and collect information and associated nursing problems through observation and interviews. Primary nursing issues included decision dilemma about receiving colostomy, postoperative pain management, and alteration of body image as a result of colostomy. Thus, we applied active listening and empathy to provide positive supports and encourage optimistic attitude for the patient and their caregiver. We also provided the patient with information about colostomy and shared the successful experience of urachal cancer treatment with the patient. The overall goal was to enhance the patient’s understanding of colostomy, increase patient’s confidence about the surgical intervention, and alleviate worry about postoperative condition, so he would be willing to receive the operation. Nursing procedures to alleviate patient’s postoperative pain and ameliorate the mental stress induced from colostomy were provided. We hope that the successful experience of this report can serve as a reference for caring similar patients in the future.