一位初次罹患肺腺癌行楔形肺葉切除之手術全期護理

Perioperative Nursing Experience of a First Time Lung Adenocarcinoma Patient Undergoing Wedge Resection

10.29494/LN.202303_24(1).0006

陳素華(Su-Hua Chen)；葉惠玲(Hui-Ling Yeh)；楊曜蓮(Yao-Lian Yang)

肺腺癌 ； 楔形肺葉切除 ； 手術全期護理 ； lung adenocarcinoma ； wedge resection ； perioperative nursing

領導護理

24卷1期（2023 / 03 / 01）

66 - 80

繁體中文;英文

本文是描述一位40歲女性，因肺腺癌行楔形肺葉切除之手術全期護理經驗，護理期間為2020年5月25日至5月28日，以Gordon十一項功能性健康型態為架構方式收集資料，確立個案有初次罹癌焦慮、暴露手術室低溫度環境及手術儀器設備、手術過程須維持左側臥姿勢相關的潛在危險性傷害及急性疼痛等健康問題。護理期間術前訪視，得知個案對於罹癌感到焦慮恐懼，故提供第一期肺腺癌手術後五年存活率為76－95%，手術後成功率95%以上之資訊，並衛教疾病相關知識，使個案放心進而降低焦慮。手術過程中，腋下放置脂肪墊，避免臂神經叢受損，雙膝放置棉被及足跟處放置平板脂肪墊預防壓傷，手術採左側臥位，使用溫毯機並在溫毯被上放置布單，避免與個案皮膚直接接觸；正確操作電燒儀器設備，避免造成電燒傷害，手術後無神經、皮膚損傷發生；手術後利用視覺等級量表來評估疼痛程度，並依據不同的疼痛指數，給予不同的止痛方式減緩疼痛。筆者經由此次照護經驗，建議可由手機建立病友會群組，藉由群組得到立即性答覆及經驗分享，且有醫護人員共同加入，即時回饋，能降低病人焦慮感，並能持續追蹤個案。

This article describes a perioperative nursing experience of a 40-year-old woman undergoing wedge resection for lung adenocarcinoma. During the nursing period from May 25 to 28, 2020, Gordon's Eleven Functional Health Types were used as a framework to collect data. It was confirmed that the case encountered health issues such as first-time cancer anxiety; exposure to the low-temperature environment of the operating room and surgical equipment, as well as the need to maintain lying position on the left side during the operation; potential savage injuries and acute pain. During the preoperative visit as part of nursing period, the author learned that the patient was anxious and fear of cancer. Thus, further information was provided about the 5-year survival rate of first-stage lung adenocarcinoma with high blood pressure is between 76%-95% and the postoperative success rate is greater than 95%. Furthermore, health and education of disease-related knowledge were taught, in order to reassure the patient and reduce anxiety. During the operation, place a pressure-relieving cushion under the arm to avoid damage to the brachial nerve plexus. Place a quilt on both knees and a flat pressure-relieving cushion on the heel to prevent pressure sores. The operation is performed with the left lateral position, and a warm blanket machine is used as well as place the sheet on the warm blanket to avoid direct contact with the case's skin. During the operation, the electric burning equipment correctly to prevent electrical burns; after operation, there were no nerve and skin damage. Furthermore, apply visual rating scale to evaluate the pain level after surgery, and provide several pain relief methods to relieve pain according to different level of pain indications. Based on this nursing experience, it is recommended that a patient association group can be established through mobile phone, which receive immediate response and experience sharing can be obtained. Medical staff can also join the group to provide immediate feedback and hence reduce patients' anxiety and continues the follow-up of cases.

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