一位獨居老人迴腸造口皮膚嚴重潰瘍之護理經驗

Nursing Experience of an Elderly Woman Living Alone with Severe Peristomal Ulceration Following Ileostomy

本文在描述一位70歲獨居女性，因上腸繫膜動脈阻塞行大腸全切除及小腸部分切除術，右腹永久迴腸造口留置，此次因造口皮膚嚴重破皮潰瘍，住院治療；面臨迴腸造口周圍皮膚照護的衝擊、壓力及預入住機構的焦慮，產生生理不適及心理負面感受。2023年3月1日至3月20日護理期間，筆者藉由互動過程、觀察、會談及身體評估等方式收集主、客觀資料，以Gordon 11項功能性健康型態為評估架構，確立個案的健康問題有「皮膚完整性受損」、「自我照顧能力缺失」及「焦慮」。並針對其健康問題，提供個別性的護理措施。密切觀察皮膚變化，提供造口皮膚潰瘍照護、飲食衛教，改善造口皮膚的狀況並增進身體舒適。運用正向心理支持，並適時轉介出院準備服務、居家個管師，整合相關資源並提供完善的居家造口自我照護計畫，教導家屬及個案照護技巧，協助料理三餐、家務，免除入住機構的焦慮，使個案出院後能回歸正常生活。藉此個案建議與鄰近醫學中心造口師合作，以報備支援方式及時介入處置，協助患者造口照護的正確知識與技巧，減輕患者心理壓力，降低再住院率，減少醫療成本支出；定期安排相關教育訓練及案例分享課程，增加護理人員的專業知識，提升照護品質。

This article discusses a 70-year-old woman living alone who had a permanent ileostomy created in her right abdomen and had previously undergone total large bowel resection and partial small bowel resection due to superior mesenteric artery obstruction . This time she was hospitalized due to a severe ulceration of the stoma skin. The impact and pressure of peristomal skin care and the anxiety of being admitted to institutional care resulted in physical discomfort and negative psychological feelings. During the nursing period from March 1 to March 20, 2023, the author collected subjective and objective data through interactive processes, observations, interviews, as well as physical assessments and adopted Gordon’s 11 Functional Health Patterns as the assessment framework, thereby establishing that the health problems faced by the patient included“impaired skin integrity,”“lack of self-care,”and“anxiety.”Individual nursing measures were then provided according to the patient’s health problems. The patient was closely monitored for skin changes, care was provided for stoma skin ulceration, and dietary hygiene education was carried out to improve stoma skin condition and physical comfort. Positive psychological support was implemented, and timely referrals were made to discharge preparation services and home personal managers. Additionally, relevant resources were integrated, and a comprehensive home stoma self-care plan was provided, which involved teaching family members and the patient care skills and assisting with meals and housework. This helped eliminate the anxiety of being admitted to institutional care and enabled the patient to return to a normal life after discharge. Based on this case, the author recommends cooperating with ostomy specialists in nearby medical centers for prompt intervention through support reporting, assisting the patient with the correct knowledge and skills for stoma care, alleviating the patient’s psychological pressure, reducing the rehospitalization rate, and decreasing medical costs. Furthermore, relevant education, training, and case-sharing courses should be regularly arranged to enhance the professional knowledge of the nursing staff and improve the quality of care.