Fallstudie: Praktische Anwendung der Selbstpflegedefizit-Theorie bei einem Patienten mit neuroendokrinem Karzinom des Duodenums

Abstract

This case describes the nursing care of a 66-year-old electively admitted patient who came to hospital for the treatment of a hepatic secondary neuroendocrine duodenum cancer. A typical liver resection with duodeno-pancreatectomy and sigmaresection was performed. Complications led to more than ten re-laparatomies with resection of the stomach and oesophagus. It was necessary to perform blind occlusion of the jejunum and the disposition of an oesophagus stoma. A diabetes mellitus was caused by the total resection of the pancreas. Mister B. got a percutaneous endoscope jejunostomy but it could not be used because of a new small intestine fistula into the abdominal cavity wherefore a port was implanted. The following different conceptions of the self-care deficit theory have been used to describe and analyse the patient situation as follows: Basic conditioning factors, self-care requisites, therapeutic self-care demands, self-care competence. The future self-management capabilities consist of the following: Care of the oesophagus stoma, care of the percutaneous endoscope jejunostomy, management of the diabetes mellitus, coping with the changed self-image, coping with the restriction of movement and with the needed prophylaxis. Support was given by the transfer of knowledge to the patient. Instructions were given during realisations of new activities and development of skills. It was evaluated if the patient is capable to reflect his actions and to assess if he is able to react on deviations from the normal standards in a correct and appropriate way. After dismissal it was secured by phone call that the patient successfully manages the new self-care demands independently.