照顧一位大腸癌導致腸阻塞患者之護理經驗

The Experience of Caring A Patient with Obstructive Colorectal Cancer

本文旨在描述一位65歲男性，因大腸癌導致腸阻塞，緊急入院接受手術，所造成的生理及心理衝擊之護理經驗。護理期間自2018年03月07日至3月20日。在照護期間運用Gordon十一項健康功能型態為評估架構，確立個案有：「潛在危險性感染」、「急性疼痛」及「焦慮」之健康問題。在照護期間，執行傷口換藥時嚴格遵守無菌技術，及維持引流管的通暢，以預防感染，進而促進傷口癒合；提供緩解疼痛的方法，如：教導採半坐臥讓腹部肌肉放鬆、固定引流管以避免受到牽扯、教導咳嗽或翻身（活動）時，按壓傷口以避免肌肉受到牽扯、並提供轉移注意力的方法；鼓勵個案說出心中的想法及感受，並針對個案所提疑問給予說明和提供疾病及治療相關知識，以增加個案對疾病治療的認知，個案獨居以及經濟困難，擔心居家照護的問題，除了教導傷口照護外，也聯絡社工和出院準備小組人員，給予經濟和居家照顧的協助，以減輕其焦慮。此次護理經驗，除護理專業的判斷與介入措施，也說明全人照護中跨領域團隊合作參與的必要性。盼藉此經驗能提供護理人員作為日後在照顧類似病患之參考。

This case report describes the nursing experience of a 65-year-old man with occurring bowel obstruction as a result of colorectal cancer. During the nursing period, which lasted from March 7th, 2018 to March 20th, 2018, the patient underwent accepted emergency surgery to deal with physical symptoms and psychological impacts. According to the data that was analyzed with the assessment tool of Gordon’s 11 functional health patterns, the result indicated that the patient’s nursing problems were potential risks of infection, acute pain, and anxiety. Throughout the caring period, various methods were provided to help alleviate patient’s pain, including teaching semi-sitting posture to relax the abdominal muscle contractions, adjusting the drainage tube to avoid being pulled, assisting on coughing and changing position pressure on the pulled muscle with wound. Distraction techniques were also given to help ease the pain, such as encouraging patients to speak their thoughts and feelings as well as explaining their concerns, and thus providing knowledge regarding disease and treatment that would enhance their insight. In addition to wound cares, the provider also contacted social workers and discharge planning staffs to accommodate financial and home care assistance to reduce the patient’s anxiety. This nursing experience illustrates the necessity of cross-disciplinary teamwork in whole-person care, in addition to the professional nursing judgment and nursing intervention, which would be helpful to other nurses that’s caring patients with similar situation. Hence, on top of the nursing assessment and appropriate interventions, in order to provide holistic care, multidisciplinary cooperation is essential.