一位甲狀腺癌病人接受氣管造口與鼻胃管後身體心像紊亂之護理經驗

Nursing experience of a Thyroid Cancer patient with body image disturbance after Tracheostomy and NG tube insertion

李俞潔(Yu-Chieh Li) ； 辛文蕙(Wen-Hui Hsin) ； 張秀美(Shiow-Mei Chang)

《馬偕護理雜誌》 11卷2期 (2017/07) Pp. 71-81

https://doi.org/10.29415/JMKN.201707_11(2).0007

摘要

本文係描述一位甲狀腺癌病人，術後因拔除氣管內管後喉頭水腫引發呼吸窘迫而緊急進行氣管造口術，合併症出現氣管食道瘻管而必須接受永久性氣切裝置，對於高社經地位的男性在術後無法面對身體外觀改變，必須協助其適應疾病、學習自我氣切及管灌食照顧技能之護理經驗。護理期間於2014年2月1日至3月10日，運用羅氏護理適應模式進行整體性評估，透過觀察、身體評估、紙筆會談收集資料，確認病人有皮膚完整性受損、身體心像紊亂及特定知識缺失等健康問題。針對皮膚完整性受損問題，運用醫療團隊共同討論治療計畫，改善因放射線治療造成的皮膚炎；護理師利用傾聽、同理心、主動關懷病人，與病人建立良好護病關係，另外針對主要護理問題：身體心像紊亂，鼓勵表達內心感受，增強其正向感，使其能接納自我，訂立護理措施，採漸進式護理指導，使病人學習新的氣管造口術及管灌食照顧特定技能。在執行護理過程中引發筆者分享探討，希望藉此護理經驗，提供護理同仁日後照顧此類患者之參考。

關鍵字

氣管造口術 ； 皮膚完整性受損 ； 身體心像紊亂

並列摘要

This article described a nursing experience of a patient who had swollen throat during endotracheal tube extubation after thyroid cancer surgery, and he received tracheostomy operation immediately due to respiratory failure. However, a tracheoesphageal fistula was found as a complication of tracheostomy surgery, and a permanent tracheostomy was instantly performed. He could not accept this appearance at first, probably related to a high socioeconomic status. Therefore, he has to learn to accept his appearance and pursue self-care skills. The nursing period was from February 1 to March 12, 2014. The Roy's adaption model was used for assessing this patient with data collected by observation, physical assessment and writing communication. A number of nursing care problems were found, including impaired skin integrity, body image disturbance and deficiency in specific knowledge regarding the tracheostoma care. Creating a trust relationship between nurse and patient was used during this care period. Eventually, he learned how to self-care and gradually accepted his body image with a tracheostoma.

並列關鍵字

Tracheostomy ； skin integrity ； body image disturbance