Hatice OLTULUOĞLU, Runida DOĞAN, Nazlıcan BAĞCI

Postoperatif İleustan Palyatif Bakıma: Olgu Sunumu

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:

Abdominal cerrahi, İleus, Palyatif bakım, Hemşire

From Postoperative Ileus to Palliative Care: A Case Report

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.

Keywords:

Abdominal surgery, İleus, palliative care, nurse,

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