一位迴腸造口周圍皮膚嚴重潰瘍病患之照護經驗

The Nursing Experience of a Patient with Severe Ulceration of Surrounding Skin of the Ileostoma

本文描述一位潰瘍性結腸炎病患接受迴腸造口術後居家自我照顧期間，因迴腸造口周圍皮膚嚴重浸潤、潰瘍及疼痛而再次住院接受治療之護理經驗。2007年1月6日至2007年1月20日期間，透過直接照顧，運用Gordon十一項功能性健康型態評估，以會談及觀察方式收集病患生理、心理、社會等資料進行分析，確立有皮膚完整性受損、疼痛、焦慮等護理問題。透過建立信任護病關係，引導參與執行造口照護，並以親水性敷料隔絕迴腸造口周圍皮膚避免排泄物侵蝕、配合服用纖維粉及緩瀉劑增加排泄物之黏稠度，並以同理心，接受病患之情緒反應，終使病患迴腸造口周圍潰瘍之皮膚癒合不再疼痛，恢復使用黏貼式造口環，排泄物不再滲漏，同時焦慮情緒降低，順利出院。由此經驗感受到照顧此類病患應於出院前特別解說其排泄物特性，務以再三回覆示教，協助病患及家屬學會造口照顧以預防合併症，希望藉此照護經驗，與護理同仁分享。This paper described a clinical nursing experience of caring a re-hospitalization patient suffering from erythematous infiltration, ulceration and pain of ileostomy. Nursing problems which consisted of impaired skin integrity, pain, and anxiety were verified after integrated assessment and data collection by observation, interviews and direct nursing care with Gordon's 11 Functional Health Patterns during the nursing period from Jan. 6 to Jan. 20, 2007. After establishing a trust relationship, encouraging participating stoma care, applying hydrocolloid dressings to prevent ileostomy from contact of defecates, increasing viscosity of defecates with medication, and providing nursing care with empathy and acceptance, the skin ulcerations healed, the pain relieved, anxiety reduced, the adhesive skin barrier was resumed, and there was no more leakage. With all these efforts, the patient discharged after repeated demonstration of stoma care with no more skin ulceration and received ileostomy takedown operation one and a half months after discharge from the hospital.