運用寧握照護一位早產兒併發壞死性腸炎之護理經驗

The Experience of Using Containment Nursing Care in a Premature with Necrotizing Enterocolitis

本文係探討一位罹患壞死性腸炎早產兒，接受迴腸切除術後留置迴腸造口的護理經驗。護理期間運用系統性身體評估、實際照護、觀察與會談方式收集資料，確立其健康問題有:低效性呼吸型態、現存性感染、營養少於身體所需、皮膚完整性受損及照顧者角色緊張。運用寧握照護，穩定呼吸氧合狀態；維護各管路之通暢與安全，及控制感染的發生；藉由支持性照護，減少肢體劇烈扭動，降低造口外滲對造口周圍皮膚之受損；與團隊擬定共同照護計畫及父母參與照護下，建立親子依附關係，增進照護知識、技能與信心，每日評估與調整進食量及TPN補充之成效，進而體重呈現穩定成長。

This article describes a nursing experience in an intensive care ward with a premature neonate with necrotizing enterocolitis after ileal resection indwelling ileostomy. During the care period of this patient, the author was involved with systematic physical evaluation, actual care, observation, and parental interview, and identified the following main issues: ineffective breathing pattern, infection, imbalanced nutrition of less than the body requirements, impaired skin integrity, and caregiver role strain. Patency of the pipeline security and infection control was maintained by supporting containment care with steady breathing oxygenation status, thus reducing the violent twisting limbs and stoma extravasation on the damaged skin around the stoma. Under the involvement of the medical team's plan and parent's participation, a parent-child attachment relationship was established. After the evaluation and adjustment of the neonate's daily food intake, steady weight growth via the effectiveness of TPN supplement was established. This improved the caregiver knowledge, skills, and confidence.