一位接受腸造口手術後的巨結腸症嬰兒之護理經驗

Nursing Experience of Caring a Baby with Hirschsprung Disease after Enterostomy

本文探討照顧一位巨結腸症嬰兒接受腸造口手術後及其家屬出院準備的護理經驗，因照護期間發現家屬面對個案疾病及腸造口照護緊張不安，又無照顧新生兒的經驗，因此引發筆者書寫此個案之動機。照護期間為2020年2月14日至2020年3月16日，筆者直接參與照護，並採行為觀察、系統性身體評估、疼痛評估與家屬會談等方式進行資料蒐集與整體性評估，確立個案及其家屬健康問題有：一、急性疼痛/與腸造口術後皮膚組織損傷有關；二、潛在危險性感染/1.與手術及侵入性處置、檢查有關；2.腸造口糞便外滲浸潤皮膚有關；三、照顧者角色緊張/缺乏疾病與腸造口照護認知有關。筆者利用嬰兒疼痛行為評估工具(NISP)進行評估，給予個別性的護理措施，提供緩解術後疼痛的方法，教導家屬腸造口術後照護預防感染的注意事項，以降低感染的風險，並鼓勵共同參與照護計畫，主動教導有關巨結腸症及腸造口等居家照護之相關資訊，以緩和主要照顧者緊張情緒以及降低照護壓力。希望藉由此次照護經驗，提供同仁在臨床照護上之參考，並建議定期舉辦有關腸造口護理之相關課程，使護理人員在照護有腸造口嬰兒時，能提供更專業的知識技能，並有系統地給予出院準備計畫，進而提升照顧者居家照護能力。

The article describes the nursing experience of caring for a patient with Hirschsprung's disease who underwent enterostomy surgery and how to assist family members in preparing for discharge. The motivation for writing this case study was the author's observation that family members were anxious about caring for a newborn after enterostomy surgery, as they lacked experience in this area.
The care period was from February 14, 2020, to March 16, 2020. The author was directly involved in the care, data collection, and overall evaluation through behavioral observation, systematic physical assessment, pain assessment, and family discussions. Three health problems were identified: Acute pain related to skin tissue damage post-surgery, risk of infection related to surgery and invasive procedures, and caregiver role strain due to lack of disease awareness and stoma care knowledge.
The author used the Infant Pain Behavior Assessment Tool (NISP) for assessment, implemented individual nursing interventions to alleviate postoperative pain, and educated parents on infection prevention post-enterostomy to reduce infection risk. Parents were encouraged to participate in the care plan and were taught relevant information about Hirschsprung's disease and enterostomy care to ease the caregiver's tension and reduce care pressure.
The author hopes that sharing this nursing experience in caring for a patient with Hirschsprung's disease will provide colleagues with valuable insights for clinical care. It is recommended to conduct regular courses on enterostomy care to enhance nursing staff's knowledge and skills in caring for infants with intestinal stomas. Nurses should also develop a systematic discharge plan to improve patient outcomes.