照顧一位婦女應力性尿失禁，術後併發急尿感個案之護理經驗

Nursing Experience of Caring for a Female Patient with Stress Urinary Incontinence Postoperative Urgency Sensation

本文描述一位八十歲女性因腹壓增加時會漏尿數個月，確診應力性尿失禁入院行經陰道恥骨吊帶術，手術後漏尿症狀改善，卻新產生急尿感無法控制之困擾，導致個案出現無力感之護理經驗。護理期間於2019年12月30日至2020年1月3日，以Gordon十一項健康功能型態評估，運用身體評估、觀察、會談及病歷查閱等方式收集資料，經評估後確認個案有排尿型態改變、急性疼痛、無力感等健康問題。護理期間提供經陰道恥骨吊帶手術成功率提升手術認知，增加個案對於手術信心。手術後第一天換藥前先告知個案需執行傷口換藥，使個案有心理準備，並且執行傷口換藥時提醒醫師採輕柔間歇地移除陰道優紗捲，減緩傷口疼痛。手術後第一天拔除導尿管可自解尿液且無應力性尿失禁，但卻併發急尿感之症狀，故藉由排尿日誌的紀錄，固定2-3小時如廁習慣，更教導每一次如廁前執行凱格爾氏運動，進而增加改善急尿症狀，減少護墊量的使用提升生活品質。出院前加強衛教日常保健行為，如飲食的調整、減重，須避免腹壓增加的行為，進而預防日後應力性尿失禁症狀之復發。建議年老個案可提供刻度較明顯且字體較大適用的量杯，以利準確登記排尿日誌。

"This case report describes the care experiences of a female patient who experienced urinary leakage for several months due to abdominal straining. A diagnosis of stress urinary incontinence was made, and the patient underwent pubovaginal sling surgery. After surgery, there was an improvement in urinary leakage when straining the abdomen, but the patient experienced an uncontrollable urge to urinate, leading to a sense of powerlessness. During the nursing period from December 30, 2019 to January 3, 2021, Gordon's Functional Assessment was used to evaluate the patient’s problems through physical assessment, observation, interview, and medical records. Three problems were identified: altered urinary elimination, acute pain, and a sense of powerlessness. On the first day after surgery, inform the patient that the wound dressing needs to be changed, so that the patient is mentally prepared, and the vaginal gauze was gently and intermittently removed to alleviate wound pain. The patient maintained a diary record of their urination habits and went to the toilet every 2-3 hours. Kegel exercises were taught to the patient to improve their urgency sensation and to reduce the use of pads. Health education was provided to the patient, and daily health behaviours, such as dietary adjustments, weight loss, and avoiding abdominal pressure, were recommended to prevent the recurrence of stress urinary incontinence in the future. The elderly must provide a measuring cup with clear scales and large fonts to accurately record voiding diary."