照護一位口腔癌復發伴隨疼痛與無力感影響病人身心理之護理經驗

本文為一位口腔癌術後不久再復發病人，面臨疼痛及攝食不足的困擾，對於腫瘤復發的病情無法掌控、懷疑治療成效，拒絕手術轉而選擇化學治療的照護經驗。護理時間自2019年7月7日至2019年8月14日，運用身體評估、觀察、會談、實際照護、查閱病歷資料等方法，從生理、心理、社會及靈性四個層面進行護理評估，確立個案主要有營養少於身體所需、疼痛及無力感等健康問題。透過飲食及營養指導提升病人的攝食量以維持體重，針對頑固性疼痛，採取藥物治療及神經阻斷術輔助疼痛控制，並透過轉移注意力及放鬆技巧等非藥物方式，提升日常生活品質；當醫療決策產生衝突時，引導家屬學習尊重個案的自主權，鼓勵雙方訴說對彼此的情感，使個案能對病程變化發展出個人因應技巧，選擇適合自己的治療方式。期望透過此個案之護理經驗，提供日後護理同儕照護之參考；並建議搭配筆談、肢體語言等增加與言詞溝通障礙者的溝通技巧，同時將家屬納入會談中，共同整合治療及照護方向，降低病人的不安和疑慮，提升對醫療團隊的信任。

關鍵字

口腔癌復發；頑固性疼痛；神經阻斷術；營養支持；無力感

並列摘要

This case study described nursing experiences of caring for an oral cancer patient who suffered from post-surgery rapid recurrence, severe pain, and poor intake. The patient opted for chemotherapy instead of surgery due to his illness. The nursing period occurred from July 7 to August 14, 2019. Research data were collected through physical examinations, observations, interviews, direct care , and medical record reviews. The patient was provided with a personal diet and nutrition intervention to maintain his body weight within the appropriate range. Furthermore, medicine and plexus block pain therapy was used to control pain, and the patient was also offered non-medicine treatments such as distract attention and relaxation methods. The patient's family members received guidance to facilitate respect for the patient's autonomy, particularly when a conflict occurred between the patient and his companions. Moreover, they were encouraged to express their feelings to each other to help the patient develop coping skills to mitigate disease progression and enhance the patient's ability to make independent decisions for suitable treatment. Thus, this study suggests that enhancing communication skills such as writing, non-verbal interactions, and body language, among individuals who are unable to speak can assist other nursing staff dealing with similar cases.

並列關鍵字

recurrent oral cancer ； intractable pain ； plexus block pain therapy ； nutrition support ； powerlessness

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