- 期刊
照護一位口腔癌病人接受皮瓣重建手術之加護經驗
Nursing Experience of a Patient with Oral Cancer and Undergoing Skin Flap Reconstruction in Intensive Care Unit
摘要
本文描述一名中年男性，經診斷口腔癌分期為T3N0M0，入院行口腔癌腫瘤切除合併自由皮瓣重建手術，術後轉入加護病房之護理經驗。因自由皮瓣重建手術及氣切留置使身體外觀改變導致個案產生身體心像問題，拒絕與親屬互動且術後受限醫囑禁止翻身無法落實胸腔護理致痰液排除困難，引發撰寫動機。護理期間自2020年5月22日至5月29日，採用直接照護、觀察、筆談及身體評估技巧收集主、客觀資料，並以Gordon十一項健康功能型態對個案進行生理、心理、社會及靈性的整體性護理評估，確立個案有組織完整性受損、呼吸道清除功能失效、身體心像紊亂等健康問題。針對上述運用護理專業提供適當且具個別性之護理計畫及措施，「組織完整性受損」以減少傷口滲液、觀察移植皮瓣變化、緩解傷口疼痛為主；「呼吸道清除功能失效」運用護理指導個案呼吸運動及有效咳嗽，以利痰液清除；「身體心像紊亂」藉由主動關懷，建立良好的護病關係，增加個案病情認知及提升生活品質，結合跨科別團隊，提供營養支持及疾病照護，促使早日痊癒，針對此疾病病人，建議提供術前衛教以減少病人生心理困擾；期望藉此護理經驗，提供護理同仁照護類似病人之參考。
並列摘要
This paper describes the nursing caring experience of a middle-aged man with stage T3N0M0 oral cancer who underwent tumor resection coupled with free flap reconstruction. Following the surgery, the patient was transferred to an intensive care unit. The physical appearance changes resulting from the surgery led to this patient experiencing the body image disturbed and withdrawing from interaction with family members. Additionally, the sputum was difficult to remove due to the prohibition of changing position by medical order and chest care after surgery. The above reasons triggered the motivation to write this case report. The nursing period spanned May 22 to 29, 2020. The nursing approach employed Gordon's 11 functional health patterns and the physical, psychological, social, and spiritual dimensions were comprehensively assessed. Subjective and objective data were collected through hands-on care, observations, writing interviews, and physical assessments, which led to the health problem identification of impaired tissue integrity, airway clearance dysfunction, and body image disturbance. Individualized nursing plans and interventions were devised to effectively address these health concerns. For impaired tissue integrity, the focus was on reducing wound exudate, monitoring the changes of transplanted skin flap, and alleviating wound pain. In cases of airway clearance dysfunction, the emphasis was on educating the patient about breathing exercises and effective coughing techniques to facilitate phlegm removal. To address the body image disturbance, the nursing strategy involved active caring, establishing a good nurse-patient relationships, increasing the patient's awareness of his own illness, and enhancing the patient's overall quality of life. A combination of these approaches, including nutritional support and an interdisciplinary team, contributed to the patient's early recovery. For patients with this disease, providing preoperative education is recommended to the mitigate psychological distress experienced by the patient. This experience is expected to serve as a valuable case study for nurses caring for patients with similar conditions.