一位短腸症患者行小腸移植手術全期護理經驗

Perioperative Nursing Care of a Patient with Short Bowel Syndrome Who Received Small Intestine Transplantation

本篇為照護短腸症患者接受小腸移植手術全期護理經驗。於2014年4月3日至5月22日照護期間，運用歐倫理論進行評估，藉由訪視會談、身體評估及觀察，確立病人出現焦慮、潛在危險性擺位傷害、潛在危險性傷口感染及現存知識缺失等問題。手術前期提供支持與教育性的護理措施，訪視傾聽及陪伴並與個案建立良好的護病關係協助減輕焦慮；手術中期維持皮膚完整性及預防潛在性傷口感染；手術後期讓個案及照顧者了解移植術後急性排斥症狀、小腸造?留置目的及居家照護知識。期望藉此經驗的分享，提供照護小腸移植患者之參考。（志為護理，2019; 18:3, 114-124） In this study, we report the experience of providing nursing care for an adult patient with short bowel syndrome who underwent small intestine transplantation. We used Orem's theory to perform the nursing evaluation. During the surgical period, the patient experienced perioperative anxiety, had potential risks of perioperative positioning injury and wound infection, lacked knowledge of the condition, and had other issues. During the preoperative period, nurses provided assistance and implemented educational measures. Likewise, visiting, listening, and accompanying the patient helped to establish a positive relationship between the patient and nurses and alleviate the patient's anxiety. To maintain patient safety and prevent unnecessary injury during the surgical period, systemic siliceous fat pads and cotton were used to protect the skin. Before surgery, we administered antibiotics and followed the principle of asepsis to prevent potential wound infection. During surgery, we pasted a waterproof film and plastic wrap around the surgical site to maintain skin integrity and prevent skin infiltration. Patients and caregivers were provided with an explanation regarding the identification of acute rejection symptoms after transplantation, the purpose of intestinal fistula retention, and home care. (Tzu Chi Nursing Journal, 2019; 18:3, 114-124)