照護一位口腔癌病人術後之護理經驗

A NURSING EXPERIENCE OF POST-OPERATIVE CARE FOR AN ORAL CANCER PATIENT

周純玉(Chun-Yu Chou) ； 洪昭安(Chao-An Hung) ； 紀慧真(Hui-Chen Chi)

《秀傳醫學雜誌》 16卷2期 (2017/12) Pp. 116-125

https://doi.org/10.3966/156104972017121602008

摘要

本文敘述一位口腔癌個案接受皮辦重建術後，因顏面外觀及功能之改變，面臨身心調適衝擊之護理經驗。運用Gordon 十一項功能性健康型態評估，以直接照護、觀察及筆談溝通等方式收集資料，確立護理問題有：呼吸道清除功能失效、疼痛、組織完整性受損及身體心像紊亂。護理過程藉由關懷陪伴個案建立護病關係，運用胸腔物理合併藥物治療，使呼吸道清除功能失效症狀改善。運用個別性護理措施及藥物緩解疼痛，藉由提供皮瓣組織護理，減少滲液及口腔異味。因術後臉部外觀改變，經護理人員與家屬主動關懷，傾聽同理個案面對術後身體心像改變歷程，使個案接受臉部改變事實。此護理經驗讓筆者體認口腔癌病人完整的護理需包含心理、社會及靈性，並落實團隊合作提供病人出院後的持續照護，僅將此經驗提供臨床護理同仁照護此類病人有所助益。

關鍵字

口腔癌 ； 皮辦重健 ； 身體心像紊亂

並列摘要

This paper discusses a nursing experience, patient underwent reconstruction, which caused changes of facial appearance and chewing function, that could lead to difficulties in metal and physical adjustment. Gordon's 11-function health patterns were used in the assessment of this case; and the data collection was performed based on clinical observation, written communication and the other skills. The patient-nurse relationship was established by accompanying and communication during the caring process. Thoracic physical therapy combined with medication were used to improve the reduced capacity of the respiratory tract's self-cleaning function. Individualized nursing measures and medication were used to relieve the acute pain. In addition, the care of flap tissue could reduce the tissue discharge and the peculiar smell of the oral cavity. The family and nursing staff provided intensive care, listening to and accompanying the patient to help him accept and adjust to the psychological effects and physical changes due to the facial deformity after the reconstruction operation. The process of nursing care, demonstrates that oral cancer patients need a comprehensive caring process, including psychological, social and spiritual support. The implementation of teamwork could provide continuing patient care after discharge. The description of this experience could be helpful for the overall clinical nursing team in the care of such patients.

並列關鍵字

Oral cancer ； flap Reconstruction ； body image disturbance