一位術後感染致腹膜炎學齡兒童之護理經驗

Nursing Experiences with a School-Aged Child with Postoperative Infection Peritonitis

本文描述一位七歲病童因術後感染致腹膜炎入院行剖腹探查及傷口引流手術之護理經驗，於99年10月11日至99年10月24日護理期間，運用Gordon十一項健康功能性型態進行資料收集與評估，確立個案的主要護理問題如下：腸胃組織灌流改變、現存性感染、身體心像紊亂、照顧者角色緊張。護理過程中，個案及父母因面對再次手術及傷口照護產生不安與害怕之情緒，經與個案和家屬建立信任關係後，運用兒童溝通技巧、持續性關懷與適時陪伴減輕病童對醫療措施之恐懼，使個案能適應身體心像改變，並願意參與身體自我照顧，提供家屬有關疾病傷口及引流管照護之完整資訊，進而解決個案之健康問題，降低家屬的焦慮。護理強調全人照護，因此照護過程不僅要重視個案本身之身心需求，主要照顧者對兒童之健康更具有深切影響，亦須列入照護之ㄧ環。筆者期許此護理報告，能提供臨床照護病童及其家屬之參考。

This article describes a nursing experience with a seven-year-old child who underwent a laparotomy and wound drainage surgeries due to postoperative infection peritonitis. Data were collected using a“Gordon 11 Functional Health Assessment tool” through observation and counseling during the period of December 11 to December 24, 2010. The main nursing problems encountered were as follows: poor tissue perfusion, infection, body image disturbance and caregiver role strain. After trust was established with the patient and her family, child communication skills were used to provide continuous care and companionship so as to alleviate the young patient’s fear of medical procedures, and to help the patient in adapting to physical and emotional changes after the surgery and becoming a willing participant in selfcare. Family members were provided with complete information regarding how to care for the wound and the drainage tube so that they could further assist the patient in resolving health issues, and thereby reduce anxiety for the whole family. The nursing process involves not only a focus on the mental and physical needs of the patient; the primary caregiver has a large influence on the child’s wellbeing as well, and must be included as a factor in care giving. This report will provide references for the clinical care of sick children and their families.