照護一位因車禍會陰撕裂傷接受暫時腸造口少女之護理經驗

Nursing Experience of a Complicated Vaginal Laceration Treated with Temporary Colostomy in a Teenager Female: A Case Report

本文描述一位18歲少女因車禍導致會陰部深層撕裂傷疑似肛門括約肌損傷，行暫時性腸造口手術之護理過程。筆者於2014年4月23日至6月16日個案住院期間，評估到此年輕的個案有輕生意念，故藉由直接照顧、傾聽、會談等技巧建立信任感並收集資料，分別以生理、心理、社會及靈性四個層面作整體性的評估，分析護理問題有：傷口感染、急性疼痛、身體心像改變。針對上述護理問題擬定護理計畫，採用適切的換藥方式及密閉式抽吸療法敷料來降低疼痛與感染、鼓勵病人表達心理感受並在建立良好護病關係後提供病人因應措施、獲得足夠的相關資訊、維護自尊及重建自我概念，使其恢復正常生活與自信讓個案能從意外傷害衝突期順利轉換為重建期勇於面對此意外及身體心像改變所帶來的衝擊， 重新適應新的生活型態，重新建立自信及執行應有的社會化功能。

 

This case report is on an 18-year-old female who sustained a deep perineal injury following a car accident. Temporary diverting colostomy was done due to suspected anal sphincter tear. During her period of hospitalization (from April 23 - June 16, 2014), various methods, such as direct nursing care and conversing in order to gather information and evaluate her condition, were used. Four aspects of holistic nursing assessment - psychological, physiologic, social, and spiritual factors, were used to analyze the nursing problem. The problem included severity of wound infection, acute pain, and body image disturbance. In order to reduce pain, infection, and gain self-confidence to return to a normal life, the nursing care plan included using the appropriate dressing method, vacuum-assisted closure, and encouragement of self-expression. The patient successfully transitioned from trauma induced conflict period to the recovery period through encouragement in facing the psychological conflict and physical change related to trauma. She was thus able to re-establish confidence, carry out social functions, and adapt to new life style.