一位食道癌接受手術個案之護理經驗

本文為敘述一位初次罹患食道癌壯年男子接受達文西手術，術後面對身上插滿多條管路的惶恐、擔心及術後進食方式的改變、空腸造瘻存留等身體心像重大改變之護理經驗。筆者護理期間自2014年2月10日至2月19日，運用觀察、傾聽、會談及身體評估等技巧收集資料，以Gordon 11項功能性健康型態評估，確認個案健康問題有：1.焦慮/與身上管路多及擔心手術後恢復有關、2.急性疼痛/與手術後傷口及管路留置有關、3.與營養少於身體所需/與疾病、空腸灌食有關、4.身體心像紊亂/與空腸造瘻存留及進食型態改變有關。筆者在照顧期間運用同理心、主動關懷與個案及家屬建立信任人際關係，積極改善術後疼痛、營養等健康問題，同時協助面對術後進食型態改變，進而以正向態度去面對改變，透過教導個案及其太太空腸造瘻居家照護，幫助個案接受術後身體心像的改變，重拾信心，讓個案及其太太共同得到良好適應，於病情穩定後順利出院返家，期待能透過此照護經驗提供日後護理類似個案之參考。

關鍵字

食道癌；身體心像紊亂；術後

並列摘要

This article describes the first time a middle-aged man suffering from esophageal cancer,after receiving the da Vinci surgery, studded with multiple lines of fear, worry, changes in eating patterns, jejunostomy persist as major changes in the body. The nursing periodranged from February 10 to 19, 2014.The primary nurse used observation, listening, talks, and physical assessment techniques to collect information according to Gordon 11 Function Health Patterns and identified the following problems: (1)anxiety,(2) pain, (3) nutrition alteration, and(4)a disturbed body image.During the caring period, I used empathy andactive care to build trust relationships with thepatient and his wife, and actively improve postoperative nutritional and other care issues such as eating pattern change in order tofacechange in a positive attitude. This helped the patientaccept his body image and rebuild confidence. He was discharged in a stable condition beforereturning home.This article may serve as a reference for nurses who care for similar patients in future.

並列關鍵字

esophageal cancer ； body image disturbance ； postoperative

參考文獻

Paik, C. N., Choi, M. G., Lim, C. H., Park, I. M., Chung, W. C. , Lee, K. M., & Chung, I. S. (2011). The role of small intestinal bacterial overgrowth in postgastrectomy patients. Neurogastroenterology and Motility, 23(5), 191-196. 191-196. doi: 10.1111/j.1365-2982.2011.01686.x

王碩盟（2013）‧達文西泌尿科手術的進展‧台北市醫師公會會刊，57（8）:36-38:2013。