一位青少女因克隆氏症引發腸穿孔之護理經驗

Experience of Providing Nursing care to an Adolescent girl with Intestinal Perforation Caused by Crohn’s Disease

本文描述一位青少女因克隆氏症引發腸穿孔之護理經驗。個案因術後腸造口留置擔心遭受異樣眼光而感到沮喪，需醫療人員給予協助，此為選案分享之理由。護理期間為2023年2月16日至3月14日，藉由觀察、會談、身體評估與直接照護方式收集資料，運用羅氏適應模式進行整體性評估，確認主要的健康問題有：急性疼痛、身體心像紊亂及社交孤立。照護過程中運用視覺類比量表（VAS）評估個案疼痛程度，止痛藥物使用、局部冷敷、執行深呼吸放鬆技巧，幫助個案在術後一周內VAS降至3分，恢復日常自我照顧活動；個案在小腸造口術後，對身體外觀的改變無法接受，使用造口教具和視覺輔助工具，包括：鏡子、衛教單張與影片，幫助個案熟悉腸造口護理步驟和技巧，引導個案參加病友支持團體，提供心理支持，幫助個案處理對身體心像的負面情緒，適應新的角色生活。個案因住院治療暫時中斷學業，對心理社會造成極大壓力，鼓勵個案通過電話、視訊和社交媒體與朋友保持聯繫，會診心理治療師提供心理諮詢，協助調整心理支持計劃，提供個別化的心理輔導，而逐漸恢復社交活動。建議未來照護此類病人可增加跨團隊合作及整體護理模式，以提升病人的生活品質和治療效果。

In this article, the experience of providing care for an adolescent girl with intestinal perforation caused by Crohn’s disease is described. The patient felt depressed owing to worries about the stigma associated with postoperative stoma and thus required assistance from healthcare professionals. This was the reason for selecting the present case for discussion. Nursing care was provided to the patient from February 16 to March 14, 2023. Data were collected through observations, interviews, physical assessments, and direct care. An overall assessment using the Roy adaptation model revealed the following main health issues: acute pain, body image disturbance, and social isolation. During the care process, a visual analog scale (VAS) was used to assess pain intensity in the patient. The adoption of measures such as analgesic use, local cold compresses, and deep breathing techniques for relaxation aided in reducing the VAS score to 3 within one week postoperatively, allowing the patient to resume daily self-care activities. Following the ileostomy, the patient found it difficult to accept the changes in her physical appearance. Therefore, instructional tools and visual aids for stoma care, including a mirror, health education leaflets, and videos, were used to assist her in familiarizing herself with the steps and techniques of post-ileostomy care. The patient was also invited to participate in a psychological support group, which aided her in dealing with negative emotions related to body image and adapting to her new role in life. Additionally, the patient experienced extreme psychosocial stress owing to the temporary suspension of her studies during hospitalization for treatment. Therefore, she was encouraged to maintain contact with her friends through phone and video calls and social media. Through psychological consultation with a psychotherapist, adjustments were made to the psychological support program to allow the patient to receive individualized psychological counseling. This led to gradual resumption of her social activities. This case highlights how transdisciplinary collaboration and a holistic care model can be incorporated into care plans for such patients in the future to enhance their quality of life and treatment outcomes.