一位食道癌手術後個案入住加護病房之護理經驗

Nursing Experience of Caring for a Patient Admitted to Intensive Care Unit After Surgery for Esophageal Cancer

葉麗敏(Li-Min Yeh) ； 陳德坤(Teck-Koon Tan)

《澄清醫護管理雜誌》 18卷2期 (2022/04) Pp. 74-83

摘要

本文探討一位食道癌手術個案，因接受食道再造術（胃管重建及空腸造口）後，入住加護病房之照護經驗。筆者自2019年4月24日至4月27日藉由直接照護觀察、身體評估、溝通及查閱病歷，運用Gordon十一項功能性健康型態評估進行資料收集，確認個案主要健康問題有：急性疼痛、營養少於身體所需、術後空腸造口灌食與傷口照護知識缺失及焦慮。筆者在護理過程中，密切觀察個案術後傷口疼痛反應，配合止痛藥物給予，教導以非藥物疼痛控制方式如轉移注意力、深呼吸及肌肉按摩以緩解疼痛；針對營養少於身體所需，給予中心靜脈導管全靜脈營養支持，再藉由空腸造口灌食提供腸道營養，每天評估空腸造口消化情形調整造口灌食熱量；運用實務操作及回覆示教練習，指導術後空腸造口灌食技巧及傷口照護知識；對於個案因疾病預後的不確定性及擔心後續治療而焦慮不安，筆者經由傾聽、關心、鼓勵及陪伴，並引導其表達心裡感受，讓個案抒發情緒及緩解焦慮，重建治療信心。希望藉此分享照護經驗，做為護理人員在臨床上護理此類個案參考，以提升臨床照護品質。

關鍵字

食道癌 ； 急性疼痛 ； 營養少於身體所需 ； 焦慮 ； 知識缺失

並列摘要

Purposes: This paper discusses the nursing experience of a patient admitted to the intensive care unit after undergoing esophageal reconstruction surgery (gastric tube reconstruction and jejunostomy) for treating esophageal cancer. From April 24 to April 27, 2019, the author collected data using Gordon's eleven functional health patterns through direct care and observation, physical assessments, communication, and reviews of medical records. It was confirmed that the main health problems the patient faces were acute pain, imbalanced nutrition (less than the body requirements), a lack of knowledge, and anxiety concerning postoperative jejunostomy feeding and wound care. During the nursing process, the author closely observed the postoperative wound pain reaction of the patient, provided analgesic drugs accordingly, and taught the patient non-drug pain control methods - such as distraction, deep breathing, and muscle massages. For problems of imbalanced nutrition (less than the body requirements), total parenteral nutritional support was provided via a central venous catheter, with enteral nutrition provided by jejunostomy feeding. The digestive situation of jejunostomy feeding was evaluated every day to adjust the calories provided via jejunostomy feeding; practical operation and teach-back exercises were applied to teach postoperative jejunostomy feeding skills and impart wound care knowledge. For the patient's anxiety (resulting from uncertainty of the disease's prognosis and concerns about subsequent treatment), the author listened to, expressed care for, encouraged, and accompanied the patient, and guided him to express his emotions so that his anxiety could be relieved, and he could rebuild his confidence in his treatment. It is hoped that the nursing experience shared here can provide a reference for nurses in caring for such cases in clinical practice to improve the quality of clinical care.

並列關鍵字

Esophageal cancer ； Acute pain ； Imbalanced nutrition (less than body requirements) ； Anxiety ； Lack of knowledge