罹患下咽癌個案接受全喉切除手術之護理經驗

Nursing Experience Involving Hypopharyngeal Cancer Patient Who Underwent Total Laryngectomy

左沛晴(Tso, Pei-Ching)

《寶建醫護與管理雜誌》 15卷1&2期 (2018/12) Pp. 49-61

https://doi.org/10.29681/PCJHM.201812_15(1_2).0006

摘要

本文探討一位罹患下咽癌的中年男性，在承受引導式化學治療副作用後，仍需接受全喉切除手術（Total laryngectomy）治療之衝擊及身心調適過程。本個案研究之護理期間為2015年6月4日至6月20日，利用會談、身體評估及病歷查閱等方式收集資料，以Gordon十一項功能性健康型態進行整體性評估，分析歸納個案有焦慮、急性疼痛、呼吸道清除功能失效、身體心像紊亂及言語溝通障礙等健康問題。依各項護理問題擬訂個別性護理計畫及措施，透過主動關懷及傾聽了解其需求，於術前提供全喉切除手術衛教本，給予個案相關護理措施及連續性的照顧，緩解焦慮，有效降低急性疼痛及維持呼吸道通暢等，並以同理心、接受及支持的態度，鼓勵個案適時表達內心感受，重新建立正向的自我概念；協助接受手術後身體外觀、結構及功能的改變，適應身體心像紊亂及重建言語溝通方式；支持個案以正向的態度面對治療計劃，藉由即時通訊軟體及電話提供出院後追蹤與諮詢。本文期望此次照護經驗能與臨床護理人員分享，並建議能主動及時滿足下咽癌個案手術後的需求、增加與他人互動及協助個案重返工作職場之臨床照護經驗。

關鍵字

下咽癌 ； 全喉切除手術 ； 護理經驗

並列摘要

This paper documented the physical and mental adjustments that were underwent by a middle-aged man who had been diagnosed with hypopharyngeal cancer for the first time while bearing the side effects of induction chemotherapy and the impact of still needing a total laryngectomy afterwards. The care period of this patient was from June 4 to June 20, 2015. Data collection was achieved via interviews, physical assessments, and medical record reviews. An overall assessment was made using Gordon's 11 Functional Health Patterns Assessment. The patient displayed anxiety, acute pain, ineffective airway clearance, body image disturbance, and speech and communication disorders. Personalized nursing plans and measures were made for each nursing problem, such as. Furthermore, the patient was actively asked how he was, his worries were listened to, and his needs were understood. A health education manual regarding total laryngectomy was provided to him before the procedure. He was also given relevant nursing care measures and continuous care to relieve his anxiety, alleviate his acute pain, and maintain a clear airway. With empathy, acceptance, and a supportive attitude, he was encouraged to express his feelings when needed to re-establish a positive self-concept. After the procedure, he was given assistance to accept the changes in the appearance, structure, and functions of his body, as well as to adapt to body image disturbance and to restore speech and communication. He was encouraged to keep a positive attitude toward the treatment plans, and follow-ups and consultations were conducted via instant messaging and phone following discharge. It is hoped that this nursing experience could be shared with nursing personnel, who are advised to actively meet the post-operative needs of hypopharyngeal cancer patients in a timely manner, prompt the patients with interact more with others, and help them return to the workplace.

並列關鍵字

hypopharyngeal cancer ； total laryngectomy ； nursing experience