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題名:一位直腸癌併發福爾尼埃氏壞疽患者之護理經驗
書刊名:長庚護理
作者:陳巧誼柯惠文廖英純
作者(外文):Chen, Chiao-yiKo, Hui-wenLiao, Ying-chun
出版日期:2015
卷期:26:1=89
頁次:頁112-123
主題關鍵詞:直腸癌福爾尼埃氏壞疽癌症護理Rectal cancerFournier’s gangreneCancer care
原始連結:連回原系統網址new window
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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。
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.
期刊論文
1.林韋君、袁素娟、黃秀梨(20101200)。營養狀況改變及護理。領導護理,11(3),21-32。  延伸查詢new window
2.Burch, J.(2011)。Management of stoma complications。Nursing Times,107(45),17-20。  new window
3.Champion, S. E.(2007)。A Case of Fournier's Gangrene。Urologic Nursing,27(4),296-299。  new window
4.Perston, Y.(2010)。Ensuring effective technique in colostomy irrigation to improve quality of life。Gastrointestinal Nursing,8(4),18-22。  new window
5.甘素寧、李來涼、傅家芸、吳淑芬(2009)。照護一位福爾尼埃氏壞疽患者之護理經驗。高雄護理雜誌,26(2),67-79。  延伸查詢new window
6.朱婉君、林美娟(20111200)。照護一位乙狀結腸癌患者術後傷口感染之護理經驗。安泰醫護雜誌,17(4),1-12。  延伸查詢new window
7.林育賢、林煌基、周燕輝、楊菘宇、鄭舉緒、洪欣瑜、謝承翰、洪維志(20091200)。Necrotizing Fasciitis Originating from Metastatic Colorectal Tumor Invasion--Case Report。中華民國整形外科醫學會雜誌,18(4),395-402。  延伸查詢new window
8.洪明嬋、梁梅芳、宋思蓉(2013)。廣泛性Fournier's壞疽治療的經驗。臺灣醫學雜誌,17(3),253-258。  延伸查詢new window
9.洪淑吟、李易靜、施素梅、陶耀華(20060400)。照顧一位腸造口老人的護理經驗。長期照護雜誌,10(1),80-90。  延伸查詢new window
10.陳淑貞、鄭麗娟(20051200)。運用羅氏適應模式於福耳尼埃氏壞疽個案之照護經驗。慈濟護理雜誌,4(4),107-119。  延伸查詢new window
11.黃家麗、唐秀燕(20111200)。一位腸造口術後患者面對身體心像紊亂之護理經驗。嘉基護理,11(2),47-57。  延伸查詢new window
12.廖芳儀、陳妮婉(20061000)。一位直腸癌行永久性結腸造口患者之護理經驗。澄清醫護管理雜誌,2(4),47-53。  延伸查詢new window
13.詹淑雅、劉芹芳、金繼春(20110400)。身體心像紊亂之概念分析。新臺北護理期刊,13(1),63-72。  延伸查詢new window
14.盧怜君、鄭春秋(20071200)。照顧一位接受永久性結腸造口病人的護理經驗。腫瘤護理雜誌,7(2),61-72。  延伸查詢new window
15.靳燕芬(20070600)。傷口換藥疼痛護理。護理雜誌,54(3),87-91。new window  延伸查詢new window
16.Bell, C.、McCarthy, G.(2010)。The assessment and treatment of wound pain at dressing change。British Journal of Nursing,19(11),4-10。  new window
研究報告
1.中華民國衛生福利部(2013)。民國101年主要死因分析。  延伸查詢new window
其他
1.衛生福利部(201402)。民國100年癌症登記報告,http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No=201404160001。  延伸查詢new window
 
 
 
 
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