照顧一位病患接受直腸癌切除併行永久性結腸造口之手術全期護理經驗

Peri-Operative Nursing Experience Of Caring A Patient Receiving Rectal Cancer Resection And Permanent Colostomy Surgery

本文探討一位直腸癌病患，經歷婆婆直腸癌術後不到半年就過世的影響，因害怕手術、拒絕西醫，選擇中醫療法，此次因腫瘤外露於肛門，嚴重影響日常生活及排泄問題，故入院治療之手術全期護理經驗。自2011年1月15日至2011年1月24日護理期間，以觀察、訪視、身體評估及病歷查閱等方式收集資料，運用Gordon 11項健康功能評估，確立個案有：焦慮、潛在危險性損傷、身體心像紊亂及自我照顧能力缺失之健康問題。術前引導個案表達內心感受，提供疾病及手術相關訊息，增加對病程發展的認知；術中以專業知識及技術，預防潛在危險性損傷；術後協助調適結腸造口對身體心像改變所帶來的衝擊，與個案及家屬共同討論結腸造口護理，並設定護理計畫，運用醫護團隊資源及親情的支持系統，於出院前協助降低對造口自我照護的不確定感與焦慮，以增進自我照顧能力，使能獲得整體性之手術全期護理。期望藉此照護經驗之分享，能提升直腸癌切除併永久性結腸造口病患之手術全期護理品質。

The purpose of this article is to explore a case of a patient with rectal cancer who feared surgery, because her mother had died within six months after receiving resection of rectal cancer and permanent colostomy surgery. The patient refused to accept modern medicine and chose traditional herbal medicine. Due to a tumor protruding out of the anus, daily life and excretory problems of the patient were seriously affected and she was admitted for further treatment. We discussed the perioperative nursing experience of this case in the paper. During the period from January 15, 2011 to January 24, 2011, we used the Gordon 11 - item functional health assessment tools and the model of perioperative care to collect the database with interviews, observation, and physical assessment. Factors including the patient’s anxiety, the risk for perioperative–positioning Injury, disturbed body image, and self-care deficit of health problems were all enrolled. Guided perioperative cases express feelings, provide disease and surgery-related information, increase awareness of the course of development; introduce surgery with expertise and technology to prevent potentially dangerous injury; discuss how colostomy surgery can help adaptation to body image changes; discuss the impact and provides colostomy care, in order to improve self-care ability to obtain integrity of perioperative nursing.