Öz
Amaç: Postoperatif ileus sık görülen, hastane yatış süresini arttıran, morbidite ve mortaliteye neden olan önemli bir komplikasyondur. Bu çalışmada abdominal cerrahi sonrası geç dönemde ileus yaşayan ve bu nedenle kolostomi açılan hastanın palyatif bakım gereksinimi ele alınmıştır.
Olgu Sunumu: 90 yaş/erkek hasta N.Ö’ye abdominal cerrahi sonrası geç dönemde ileus oluşması nedeni ile kolostomi açılmıştır. Yoğun bakımda 27 gün yatırılan hasta taburculuk sonrası evde takip edilmiştir. Yoğun bakımda gelişen basınç yarası evde evrelendirilemeyen basınç yarası haline gelmiştir. Bununla birlikte genel durum bozukluğu da meydana gelen hasta 27.07.2022 tarihinde palyatif bakım servisine yatırılmıştır. Servise konfüze olarak yatırılan hastanın kol ve bacaklarında kontraktür geliştiği, ağrısı olduğu, malabsorbsiyonu, sıvı-elektrolit dengesizliği, asidozu ve sekresyona bağlı solunum problemi yaşadığı belirlenmiştir. Hemşirelik girişimleri sonucunda; oral R 1-2 başlanmış, basınç yarası 2. evreye gerilemiş, iştahı ve oksijen satürasyonu artmış, ağrısı ve sekresyonları azalmıştır. Ancak kontraktürlerinde azalma gözlenmemiş ve güvenli çevreyi sağlama/sürdürme ile ilgili riskleri devam etmektedir.
Çıkarımlar: Hastaya verilen bakım ve izlemlerin sonucunda, hastanın kliniğe yatırıldığında görülen semptomlarında önemli ölçüde azalma olduğu belirlenmiştir. Hasta ve hasta yakınlarını bilgilendirmek amacıyla hemşirelik bakım planları doğrultusunda hazırlanan taburculuk eğitimi içeriğinde; ileusun nedenleri, belirti ve bulgularına yönelik bilgilerin yer alması önemlidir.
Anahtar Kelimeler
Kaynakça
- Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clinical Nutrition. 2015;34(3):367–76.
- Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. Journal of Visceral Surgery. 2016;153(6):439–46.
- Drake TM, Ward AE. Pharmacological management to prevent ileus in major abdominal surgery: a systematic review and meta-analysis. Journal of Gastrointestinal Surgery. 2016;20(6):1253–64.
- Sugawara K, Kawaguchi Y, Nomura Y, Suka Y, Kawasaki K, Uemura Y, et al. Perioperative factors predicting prolonged postoperative ileus after major abdominal surgery. Journal of Gastrointestinal Surgery. 2018;22(3):508–15.
- Çardaközu T, Aksu C. Abdominal Cerrahide Anestezi. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi. 2019;5(1):47–53.
- Kamalak Z, Köşüs N, Köşüs A, Kalem Namli M, Hızli D, Akçal B, et al. Chewing Gum: A Funny Way Opposed to Postoperative Ileus for Gynecological Operations. The Journal of Gynecology-Obstetrics and Neonatology. 2015;12(3):119–22.
- Harnsberger CR, Maykel JA, Alavi K. Postoperative Ileus. Clinics in colon and rectal surgery. 2019;32(3):166–70.
- Wells CI, Milne TGE, Seo SHB, Chapman SJ, Vather R, Bissett IP, et al. Post-operative ileus: definitions, mechanisms and controversies. ANZ Journal of Surgery. 2022;92(1–2):62-8.
- Sommer NP, Schneider R, Wehner S, Kalff JC, Vilz TO. State-of-the-art colorectal disease: postoperative ileus. International Journal of Colorectal Disease. 2021;36(9):2017–25.
- Er S, Kocatepe V, Kahramantürk G, Uğur E. The Nursing Care of the Geriatric Patient with Trauma Treated in Intensive Care Unit Based on the Gordon’s Functional Health Patterns Model. Yoğun Bakım Hemşireliği Dergisi. 2019;23(1):36–42.
- Weledji EP. Perspectives on paralytic ileus. Acute Medicine & Surgery. 2020;7(1):e573.
- Usta E, Aygin D. Why Should Postoperative Care of Elderly Patients Different be? Journal of Duzce University Health Sciences Institute. 2015;5(3):59–65.
- Zietlow KE, Wong S, Heflin MT, McDonald SR, Sickeler R, Devinney M, et al. Geriatric Preoperative Optimization: A Review. The American Journal of Medicine. 2022;135(1):39–48.
- Ibitoye S, Braude P. Geriatric perioperative care. Medicine. 2021;49(1):51–5.
Öz
Aim: Postoperative ileus is a common complication that increases the length of hospital stay and causes morbidity and mortality. In this study, palliative care needs of a patient, who had ileus in the late period after abdominal surgery and therefore had a colostomy, are discussed.
Case report: In this 90 years old/male patient, N.Ö., colostomy was opened due to ileus formation in the late period after abdominal surgery. The patient, who was hospitalized in the intensive care unit for 27 days, was followed up at home after discharge. The pressure ulcer that developed in the intensive care unit has become a pressure ulcer that cannot be staged at home. The patient, whose general condition was impaired, was admitted to the palliative care service on 27.07.2022. The patient was admitted to the unit as confused with contractures in his arms and legs, pain, malabsorption, and fluid-electrolyte imbalance. It was determined that he had acidosis and secretion-related respiratory problems. As a result of the applied nursing interventions, oral R 1-2 was started, the pressure ulcer regressed to stage 2, his appetite and oxygen saturation increased, and his pain and secretions decreased. However, no reduction in contractures has been observed and the risks associated with providing/maintaining a safe environment remain.
Inferences: As a result of the care and follow-up given to the patient, it was determined that there was a significant decrease in the symptoms observed when the patient was admitted to the clinic. In the content of the discharge training prepared in line with the nursing care plans to inform the patients and their relatives, it is important to include information about the causes, signs, and symptoms of ileus.
Anahtar Kelimeler
Kaynakça
- Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clinical Nutrition. 2015;34(3):367–76.
- Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. Journal of Visceral Surgery. 2016;153(6):439–46.
- Drake TM, Ward AE. Pharmacological management to prevent ileus in major abdominal surgery: a systematic review and meta-analysis. Journal of Gastrointestinal Surgery. 2016;20(6):1253–64.
- Sugawara K, Kawaguchi Y, Nomura Y, Suka Y, Kawasaki K, Uemura Y, et al. Perioperative factors predicting prolonged postoperative ileus after major abdominal surgery. Journal of Gastrointestinal Surgery. 2018;22(3):508–15.
- Çardaközu T, Aksu C. Abdominal Cerrahide Anestezi. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi. 2019;5(1):47–53.
- Kamalak Z, Köşüs N, Köşüs A, Kalem Namli M, Hızli D, Akçal B, et al. Chewing Gum: A Funny Way Opposed to Postoperative Ileus for Gynecological Operations. The Journal of Gynecology-Obstetrics and Neonatology. 2015;12(3):119–22.
- Harnsberger CR, Maykel JA, Alavi K. Postoperative Ileus. Clinics in colon and rectal surgery. 2019;32(3):166–70.
- Wells CI, Milne TGE, Seo SHB, Chapman SJ, Vather R, Bissett IP, et al. Post-operative ileus: definitions, mechanisms and controversies. ANZ Journal of Surgery. 2022;92(1–2):62-8.
- Sommer NP, Schneider R, Wehner S, Kalff JC, Vilz TO. State-of-the-art colorectal disease: postoperative ileus. International Journal of Colorectal Disease. 2021;36(9):2017–25.
- Er S, Kocatepe V, Kahramantürk G, Uğur E. The Nursing Care of the Geriatric Patient with Trauma Treated in Intensive Care Unit Based on the Gordon’s Functional Health Patterns Model. Yoğun Bakım Hemşireliği Dergisi. 2019;23(1):36–42.
- Weledji EP. Perspectives on paralytic ileus. Acute Medicine & Surgery. 2020;7(1):e573.
- Usta E, Aygin D. Why Should Postoperative Care of Elderly Patients Different be? Journal of Duzce University Health Sciences Institute. 2015;5(3):59–65.
- Zietlow KE, Wong S, Heflin MT, McDonald SR, Sickeler R, Devinney M, et al. Geriatric Preoperative Optimization: A Review. The American Journal of Medicine. 2022;135(1):39–48.
- Ibitoye S, Braude P. Geriatric perioperative care. Medicine. 2021;49(1):51–5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Hemşirelik |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Nisan 2023 |
| Gönderilme Tarihi | 8 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 3 Sayı: 1 |
Kaynak Göster
AIJHS dergisi ve AIJHS'de yayımlanan tüm makaleler Creative Commons Atıf-Gayri Ticari 4.0 Uluslararası Lisansı ile lisanslanmıştır.