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長庚護理

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篇名 一位直腸癌併發福爾尼埃氏壞疽患者之護理經驗
卷期 26:1=89
並列篇名 Nursing Experience of a Patient with Rectal Cancer Complicated with Fournier’s Gangrene
作者 陳巧誼柯惠文廖英純
頁次 112-123
關鍵字 直腸癌福爾尼埃氏壞疽癌症護理rectal cancerFournier’s gangrenecancer care
出刊日期 201503
DOI 10.3966/102673012015032601011

中文摘要

本文描述一位直腸癌併發福爾尼埃氏壞疽之64歲男性個案,經過清創術及腸造口手術治療後,除了面臨傷口疼痛造成的生理問題,更伴隨著因身體構造改變而產生的負向自我感受。筆者護理期間自2012年3月23日至2012年4月27日,藉由觀察、會談及非語言溝通的方式收集資料,運用Gordon十一項功能性健康評估工具,發現個案有組織完整性受損、營養少於身體需要、急性疼痛、身體心像紊亂及社交隔離等健康問題,本文針對急性疼痛、營養少於身體需要及身體心像紊亂之主要健康問題提出護理計畫。於護理期間,筆者透過主動關懷,傾聽個案需求及對自身疾病的感受,尊重其想法,鼓勵個案參與腸造口及傷口照護,並運用醫療團隊資源,包括醫師、營養師、社工師及直肛治療室技術師,與家屬共同討論照護模式,針對主要健康問題提供個別性的照護,如減輕術後傷口疼痛,提供營養支持,幫助個案重建正向的身體心像,增進腸造口及傷口照護認知,以提升自我肯定,並利用社會支持系統申請醫療補助,助於個案回歸正常生活。

英文摘要

This nursing case study is about a 64-year-old male patient with rectal cancer complicated with Fournier's Gangrene. The study illustrates this patient’s physical and psychological responses to the physical challenges after debridement and colostomy. The nursing care period was from March 23 to April 27, 2012. During this period, the patient's information was collected by the author through observations, conversation, and nonverbal communication . Gordon 11 Function Health Patterns was adopted to evaluate patient's general condition. The author had discovered that the patient had multiple health problems, including impaired tissue integrity, poor nutrition status, acute pain, body image disturbance, and social isolation. The care plan focused on patients’ primary physical problems: acute pain, poor nutrition status, and body image disturbance. During this nursing period, the author listened to the patient's needs and feelings actively, with respect and understanding. The author encouraged the patient to participate in colostomy and wound care. Doctors, dietitians, social workers, and ST room technicians were also counseled to help educate the patient’s family members to prepared themselves in individualized care, which consists of reducing physical pain, providing adequate nutrition support, helping reconstruction of positive body image, and educating about preparation for patient’s surgical wound and colostomy care. With the financial assistance from the social support system, the patient was expected to be able to return to his normal life.

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