照護一位巨結腸症嬰兒術後及出院準備之護理經驗

A Postoperative Nursing Care Experience And Discharge Plan-ning of An Infant with Megacolon

本文描述一位巨結腸症嬰兒術後及出院準備之護理經驗，照護期間自2019年3月5日至2019年3月13日，筆者直接參與照護、觀察嬰兒行為、執行身體及疼痛評估、與家屬訪談及運用羅氏適應模式進行資料蒐集與評估，確立個案有急性疼痛、潛在性危險感染之護理問題，更發現案母面對個案術後傷口及擔憂術後合併症，及返家照護不易充滿不安，導致壓力及緊張，有照顧者角色緊張之護理問題。照護過程中利用量化性嬰兒疼痛行為評估工具（NISP）進行評估，給予個別性護理措施，提供物理及藥物之減輕疼痛方法，緩解術後疼痛，教導案母術後傷口照護、預防感染、學會觀察感染症狀、返家照護技巧及注意事項，透過提供適合的術後照護指導，確實緩和主要照顧者緊張不安情緒以及降低照護壓力。過程中筆者深切體會嬰兒不會說話，無法以言語表達，故需運用客觀的疼痛評估工具。而主要照顧者面臨的壓力往往超過我們的想像，護理人員在醫療第一線，若能即時評估即早發現護理問題，給予個別性適合的護理措施，不僅能降低潛在性傷害，也能增進家庭間親子依附關係及家庭凝聚力，進而提升居家照護品質。期望藉此護理經驗分享，提供臨床護理人員照護此類個案之參考。

This study described a postoperative nursing care experience and dis-charge planning of an infant with Megacolon from March 5 to 13, 2019. The authors directly participated in care, observed the behavior of the infant, performed physical and pain assessment, and interviewed with family members. Data were collected and analyzed based on Roy's adaptation model. It was found that the infant demonstrated acute pain and potential infections. Care-giver role strain was noticed while the mother revealed stress in facing postoperative wounds and complications after returning home. Neonatal Infant Pain Scale (NIPS) was used for nursing assess-ment in this study. Individualized nursing care and pain relief interven-tion, such as physical therapy and medication were conducted. Post-operative wound care instruction was provided to the care-givers to ob-serve infection symptoms and prevent infection. The primary caregiv-er's stress and anxiety were eased and reduced after postoperative care instructions. An objective pain assessment was performed due to the inability of the infant to express verbally. The primary care-givers are under tre-mendous pressure, so it is important for nursing professionals to pro-vide individual nursing instruction timely to reduce potential damage, enhance parental attachment and family cohesion, and im-prove home care quality. It is expected that this study provides clinical experiences for those who work with patients with Megacolon and their families.