결장루형성술 환자간호를 위한 일 연구

Abstract

This study is designed to find out proper nursing activities for the needs of the colostomy patients, i.e., mental and psychological as well as physical needs for rapid recovery, and to help them build up the follow-up care for proper social adjustment. The study is based on 268 cases out of 381 colostomy patient's records kept in Ewha Womans University Hospital, Yonsei Medical Center, and National Medical Center in between the period from Jan. 1953 to Jan. 1970. The items of study are mainly on etiology, sex, age, duration of hospitalization, mortality rate, seasonal frequency, time from the onset of illness to the admission of the hospital, signs and symptoms. 1. Frequency of onset by etiology: Neoplastic disease 112 cases(42％), Imflammatory disease 33 cases (12％), Congenital malformation 30 cases(ll％), Intussusception 25 cases (9.3％), Trauma 24 cases (9％), Volvulus 17 cases (6.3％), and Crohn's disease 6 cases (2.2％). 2. By sex: male 167 cases (62.9％), and female 101 cases (37.1％). So the ratio of portion of male and female 2:1. 3. By age: under l-year-old 27 case (10.1％) highest, 41-50 yrs 54cases (20.2％), 51-60 yrs 42 cases (15.5％), above 71 yrs 5 cases(l.9％). 4. Duration of hospitalization: the shortest is 2~days and the longest is 470 days. l-20-days 52％, 40-60 days 14％. 5. Mortality rate: Under the 10-days-admission 19.5％ and the beyond 30-days-admission 3.9％. 6. Seasonal frequency: Higher in summer (32％). 7. Signs and symptoms: abdominal pain (56％), abdominal distention (54％), vomiting (40％), bloody mucoid diarrhea (38％), pain of anal region (18％), abdominal tenderness, anorexia, indigestion, constipation, disuria, tenesmus, high fever and chilly; sensation, bile tinged vomiting. Nursing activities for the patient's physical needs are as follows: Skin care for colostomy region, Prevention of colostomy constraction and depression, Removal of an offensive odor, The use of colostomy bag-selection for, and demonstration of the use of inexpensive colostomy irrigation equipment, Personal hygiene, general skin care, care of hair, finger nails and toe-nails, Oral hygiene, sleep and rest, adquate, Daily activities, ete. Measures for regulation of bowl movement. keeping the instruction of taking food, preparing the meal and help for anorexia, constipation and it's solution, prevention of diar□hea, helping the removal of mucous, and stretch constricted stoma as needed. Nursing activities for pt's socio-psychological needs are as follows: - help the patient to make decision for the operation, - remove pt's anxiety toward operation and anesthesia, - to meet the pt's spiritual needs at his death beet, - help to establish, family and friends cooperation, - help to reduce anxiety at the time of admission and it's solution, - help to meet religious need, - help to remove pt's anxiety for loosing his job and family main-taioance. Follow-up studies for 7 cases have been done to implement the present thesis. The items of the personal interviews with the patients are as follows: - acceptability for artificial anus, - the most anxious thing they had in mind at the time of discharge, - the most anxious thing they have in mind at present. - their friends and family's attitudes toward the patient after operation - relations with other colostomy patients - emotional damage from the operation - physical problem of enema, irrigation, - control of diet - skin care - control of offensive odor, - patient's suggestions to Nurses during hospital stay and after discharge. In conclusion, the follow-up care for colostomy patients shares equal weight or perhaps more than the post-operative care. The follow-up care should include the spiritual care for moral support of the patient, to drag him out of isolation and estrangement, and make him fully participate insocial activities. It is suggested that the following measures would help to rehabilitate the colostomy patients (1) mutual acquaintance with other colostomy patients if possible form a sort of club for the colostomy patient to exchange their experiences in care (2) through the team work of doctor, nurse and rehabilitation specialists, to have a sort of concerted, effort for betterment of the patient.