照顧一位腸皮膚瘻管個案之護理經驗

The Nursing Experience of Caring for a Patient with Enterocutaneous Fistula

本文旨在照顧一位女性因第一孕期施行人工流產造成小腸穿孔，術後因腸吻合處滲漏造成腸皮膚瘻管個案之護理經驗。護理期間自2006年5月22日至6月21日，以Gordon十一項健康功能型態評估，確立個案護理問題有組織完整性受損、焦慮、身體心像紊亂與性生活型態改變等。照護過程中，應用醫療團隊合作模式，提供個案生理照護，緩解不適；建立良好的護病關係，引導個案說出害怕、焦慮感受以及面對身體心像改變的事實。提供自我照顧知識及相關醫療諮詢等減輕其心理社會壓力。出院後以電話與門診追蹤，提供了個案整體性與持續性之照護訊息，使其能儘早回歸家庭與社會。

This report describes the nursing experience of caring for a woman who had intestinal complications due to the development of an enterocutaneous fistula resulting from anastomotic leakage after receiving artificial abortions in the first trimester. The duration of nursing care was from May 22(superscript nd) to June 21(superscript st), 2006. The primary nurse used Gordon's Functional Health Patterns to identify the patient's health problems. The following nursing problems were subsequently found: impaired skin integrity, sleep pattern disturbance, anxiety, body image disturbance and altered sexuality pattern. Care during this period was provided by a multi-disciplinary team to relieve the patient's discomfort. We also used communication skills such as listening to the patient's voice, mutual contact and sustained support to construct a good nurse-patient relationship. After having formed a good relationship, we guided the patient to share her feelings about her fears, anxiety and change in body image. We also provided knowledge about self-care and relevant medical consultation for the patient. Furthermore, by using telephone interviews and outpatient follow-up, we succeeded in providing continuous and integral care.