一位病態性肥胖病人接受胃縮小手術之全期護理

Perioperative Nursing Care for a Morbid Obese Patient who Underwent Sleeve Gastrectomy

本文描述協助一位病態性肥胖的未婚女性，面對手術治療的衝擊及術後自我照顧問題，最終成功適應手術過程的護理經驗。自2014 年6 月9 日至6 月13 日之照護期間，筆者以Orem 自我照顧理論進行評估，運用手術全期護理模式，利用訪談、傾聽、觀察及部分照護等方式，對個案進行身體、心裡及社會等方面的整體性評估。確立個案有焦慮、潛在危險性傷害及感染、疼痛和知識尋求行為等主要健康問題，針對個案的健康需求提供個別性計劃及措施；藉由主動關懷、同理、傾聽引導個案表達內心感受，並提供手術相關的訊息增加個案對手術之認知，協助個案在手術前減輕面對手術的焦慮；手術中運用專業知識及技巧預防發生潛在危險性手術情境的傷害，使其安全渡過手術過程。手術後探視個案並教導減輕疼痛的方式，協助個案順利恢復健康；恢復期間教導並提供個案及家屬有關出院自我照顧之衛教及尋求資源的方法等，協助個案積極地面對及調適，成功適應恢復原有的生活品質。建議未來能成立個案管理師，提供病人連續性、整體性的護理照顧，讓病人能得到更高的護理品質。期望藉由此經驗的分享，提供日後照護相關病人手術全期臨床實務之參考。

This article describes a morbidly obese female. She suffered the impact of a surgical cure and postoperative self-care issues. Finally she adapted perioperative nursing before a surgical procedure. The nursing period was from June 9 to June 13 in 2015.
The author used various techniques, such as Orem self-care theory, perioperative nursing mode, interviews, listening, observing and partial care, and evaluated the overall assessment of body, mind and society.
It was found that she had some health problems such as anxiety, risk of injury and potential infection, pain, and so on, as well as knowledge seeking behavior.
The author provided an individual plan and policy to meet the health demands in this case.
Caring, empathy, listening, letting the patient express her feelings, and providing knowledge about the surgery to help the patient understand were applied to reduce anxiety before surgery.
We can use professional knowledge and skills to prevent the occurrence of potential dangerous situations and surgical damage and make promote the safety of surgical procedures. After surgical operations, by caring for patient and teaching ways to reduce pain, we can help patients restore health successfully and quickly. During the recovery period, by teaching and providing health education,patients can learn how to take care of themselves and access medical resources.This can help the patient to adapt to their perioperative nursing positively and restore the original quality of life successfully.
This study suggests establishing a case management division in the future to provide patients with continuous and complete perioperative nursing and achieve higher quality care. Hopefully the experiences shared here can serve as a reference or perioperative nursing in the future.