照顧一位直腸癌患者行腹腔鏡腹部會陰切除術之手術全期護理

A Perioperative Nursing Experience of A Patient with Rectal Cancer Undergoing Laparoscopic Abdominal Perineal Resection

本文探討一位直腸癌患者接受永久性結腸造口之手術全期護理經驗，於2015年4月22日至5月2日照護期間，藉由訪視、觀察、身體評估、會談及病歷查閱等方式收集資料，運用Gordon11項健康功能型態評估，進行手術全期分析，確立個案有：焦慮、潛在危險性損傷、知識缺失及身體心像紊亂等護理問題；藉由手術全期護理師的角色，運用支援、教育性技巧，使個案於術前減輕疑慮、接受手術，術中提供全程防護，確保個案手術安全無潛在性傷害發生，術後與個案、家屬共同討論並設定護理計劃，運用醫護團隊力量、親情及病友的支援系統，得以自我調適重拾信心，進而提升自我照顧能力，並於出院後恢復日常生活，維持良好生活品質。

This case report described a perioperative nursing experience of an elderly patient with rectal cancer undergoing laparoscopic abdominal perineal resection. Data were collected via visitation, direct observation, physical examination, conversation and chart review. The nursing period was from April 22 to May 20, 2015. A perioperative analysis was conducted with Gordon’s Functional Health patterns as framework. Four health-related problems were identified: anxiety, risk for injury, knowledge deficit and body image disturbance. Nursing interventions included psychological support and skillful education to reduce the patient’s anxiety, safety protections during operational procedures and formulating a postoperative care plan with the patient and families. With the assistance of the medical team and support systems from family and other patients, we helped the patient to regain confidence, promote postoperative self-care, accelerate postoperative rehabilitation and maintain a good quality of life.