一位老年食道癌病人行空腸造口之護理經驗

Nursing Experience of an elderly Patient with Jejunostomy for Esophageal Cancer

10.29494/LN.202106_22(2).0007

王麗晴(Li-Ching Wang)；廖敏季(Min-Chi Liao)

老年 ； 食道癌 ； 空腸造口 ； elderly ； esophageal cancer ； jejunostomy

領導護理

22卷2期（2021 / 06 / 01）

96 - 111

繁體中文

本文為照護一位72歲中老年男性，面對罹患食道癌及空腸造口手術之壓力，術後更需面臨由空腸造口進行灌食，身體心像改變的衝擊，且焦慮自己與太太能否正確執行灌食之護理經驗。護理期間為2018年9月11日至10月6日，運用Gordon十一項功能型態評估及藉由身體評估、觀察、訪談、傾聽等方式收集資料，確立個案主要健康問題有：（1）營養少於身體所需／與食道癌造成吞嚥困難及熱量攝取不足有關；（2）焦慮／因食道癌需行空腸造口手術、進食方式及身體外觀改變有關；（3）照顧者角色緊張／與空腸造口照護不熟悉有關。筆者於照護期間與營養師、傷口照護師、腫瘤個管師共同討論飲食攝取計畫，指導空腸造口正確照護，予止痛藥物控制疼痛並教導放鬆技巧及採舒適臥位，以及指導後續接受化療營養攝取注意事項。藉由回覆示教及依個案及案妻的教育程度、慣用語言考量，錄製台語版的空腸造口照護及管灌技巧短片存於個案手機，並指導觀看的操作步驟，使能加深空腸造口照護的印象，緩解焦慮提升自信心；在家人及醫護人員的支持下，主動與病友互動，接受身體心像改變之事實。期望將此照護經驗，提供給照護類似個案之護理師參考，讓個案能有個別性照護及提升生活品質。

This case study is about the nursing experience of a 72-year-old man with esophageal cancer who underwent jejunostomy operation. After the operation, he had to face nutritional intake via the opening of the jejunum, and the impact caused by changes of the body psychogram. The patient was anxious about whether he or his wife could perform jejunostomy nursing and feeding correctly. The nursing period was from September 11 to October 6, 2018. Gordon's 11 functional health patterns were utilized and data collection methods such as physical assessment, observation, interview, and listening were conducted. The main health issues were identified as: (1) Less nutrition than physical needs was associated with dysphagia and insufficient calorie intake due to esophageal cancer; (2) Anxiety due to jejunostomy and changes in eating patterns and changes in body appearance caused by esophageal cancer; (3) The caregiver gets tensed as she was unfamiliar with jejunostomy nursing. The author organized the dietary intake plans with dietitians, associated care with wound care practitioners, as well as oncologists, guides the correct care of jejunostomy, relaxation techniques education, and also guides subsequent Chemotherapy Precautions for nutritional intake. By responding to the teaching and considering the educational level of the case and the wife, and the language used, the Taiwanese version of the jejunostomy care and irrigation techniques short film was recorded on the mobile phone in this case, and the operation steps for viewing were guided, It aims to deepen the impression of jejunostomy care, relieve anxiety and improve self-confidence. Under the support of family members and medical staff, actively interact with other patients, the patient gradually accept the fact of the body image change. It is anticipated that this nursing experience serves as a reference for caregivers when caring for similar cases to receive individualized nursing care and hence improved their quality of life.

1. 金盈君,謝佩穎,張慈惠(2015)。降低食道癌病人空腸造瘻管阻塞率。護理雜誌，62(3，附冊)，30-38。
   連結：
2. 高玉鳳,鄭惠蘭,李淑慧(2019)。灌食訓練計畫對食道癌病患營養狀態之成效探討。腫瘤護理雜誌，19，39-52。
   連結：
3. 鄒茵茵,張聿仁,黃慧雯,童惠芳,白玉珠(2015)。建立食道癌病人空腸造瘻之臨床照護指引。腫瘤護理雜誌，15(1)，25-38。
   連結：
4. 謝伊晴,邱哲琳,楊雀戀(2018)。食道癌病人的營養照護。臨床醫學，82(6)，720-724。
   連結：
5. Paik, C. N.,Choi, M. G.,Lim, C. H.,Park, J. M.,Chung, W. C.,Lee, K. M.,Jun, K. H.,Song, K. Y.,Jeon, H. M.,Chin, H. M.,Park, C. H.,Chung, I. S.(2011).The role of small intestinal bacterial overgrowth in postgastrectomy patients: Bacterial overgrowth and gastrectomy.Neurogastroenterology and Motility,23(5),e191-e196.
6. Scott, R.,Bowling, T. E.(2015).Enteral tube feeding in adults.The Journal of the Royal College of physicians of Edinburgh,45(1),49-54.
7. Xiao-Bo, Y.,Qiang, L.,Xiong, Q.,Zheng, R.,Jian, Z.,Jian-Hua, Z.,Qian-Jun, Z.(2014).Efficacy of early postoperative enteral nutrition in supporting patients after esophagectomy.Minerva Chirurgica,69(1),37-46.
8. Yarbro, C. H.(Ed.),Wujcik, D.(Ed.),Gobel, B. H.(Ed.)(2011).Cancer nursing: Principles and practice.Sudbury, MA:Jones and Bartlett.
9. 林柏任,吳文傑,周益聖,徐博奎,林志陵,廖麗瑛,陳冠仰(2018)。食道鳞狀上皮癌現今治療進展。內科學誌，29(1)，28-37。
10. 許玉娟,成佳憲,李章銘,黃培銘,陳佳慧(2016)。食道癌患者於治療期間面臨的困境與其照護策略。臺灣醫學，20(6)，34-41。
11. 衛生福利部國民健康署（2019，06 月 21 日）． 2018 年國人死因統計結果‧取自 https://www.mohw.gov.tw/cp-16-48057-1.html