一位下咽癌行全喉切除手術病人之照護經驗

Nursing Experience of a Hypopharyngeal Cancer Patient with Total Laryngectomy

黃詩婷(Shih-Ting Huang) ； 陳繪竹(Hui-Zhu Chen) ； 王姮樺(Heng-Hua Wang) ； 鄭碧芬(Pi-Fen Cheng) ； 王美惠(Mei-Hui Wang)

《高雄護理雜誌》 36卷1期 (2019/04) Pp. 55-66

https://doi.org/10.6692/KJN.201904_36(1).0006

摘要

本文描述一位下咽癌接受全喉切除手術之個案，術後面臨永久性氣切造口影響外貌及溝通模式改變之護理經驗。照護期間自2017年2月5日至2月20日，運用Gordon十一項功能性健康型態進行整體性評估，確立健康問題有呼吸道清除功能失效、言詞溝通障礙及身體心像紊亂。提供個別化護理措施，給予抽痰並教導有效性咳嗽技巧，維持呼吸道通暢；與個案討論溝通替代方法與工具，提供復聲資源，轉介無喉病友團體；給予傾聽並理解個案的需求，利用服裝修飾氣切造口，引導個案正視自我價值，以正向態度適應身體外觀的改變，重新學習因應方法。期望日後透過全喉切除手術照護標準的制訂，可幫助同仁盡早擬定照護計畫及介入措施，更加精實照護品質。

關鍵字

下咽癌 ； 全喉切除手術 ； 言詞溝通障礙 ； 身體心像紊亂

並列摘要

The paper depicts the experience of caring for a hypopharyngeal carcinoma patient with total laryngectomy, who confronted changes of both appearance and communication method for permanent tracheostomy. From 5th to 20th of February, 2017, Gordon's 11 functional health patterns were employed to perform overall evaluation of the caring experience. After analysis and rearrangement of information, the health problems established were failure of clearance function of the respiratory tract, language barriers in communication, and body image disturbance. In the caring process, individualized caring measures were taken. Based on the real needs of the patient, he was given sputum suction, and taught effective coughing techniques to maintain airway patency. Before surgery, development of alternative methods and tools of communication were discussed with the patient. The patient was also provided with resources of speaking voice resumption, and introduced to support organizations of laryngectomees. All through the process, the patient was given support over his concerns, empathy was expressed, and his needs were listened to and understood. Special clothing was used to cover the tracheostomy. The patient was also guided to build up self-worth, and to take a positive attitude to adapt himself to the change of his physical appearance, reestablish self-confidence, and resume his normal life as soon as possible. The unit developed and implemented the standards for caring for total laryngectomy patients in the future to advance the quality of nursing care.

並列關鍵字

hypopharyngeal cancer ； total laryngectomy ； language barriers in communication ； body image disturbance

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