一位年輕女性罹患口腔癌行顯微皮瓣重建術後之照護經驗

Nursing Experience of a young female with oral cancer after free-flap micro-reconstructive surgery

10.6692/KJN.202005/SP_37.0012

蔡佩君(Pei-Jiun Tsai)；林采蓉(Tsai-Rung Lin)

年輕女性病人 ； 口腔癌 ； 身體心像改變 ； young female patient ； oral cancer ； physical and psychological change

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

137 - 147

繁體中文

本文主要敘述一位23歲女性病人因罹癌口腔癌，接受口腔廣泛性腫瘤切除及皮瓣重建手術，經歷三次手術產生生理、心理衝擊之照護經驗。照護期間2018年6月15日至6月20日運用觀察、會談、身體評估及查閱病歷等方式收集資料，針對其生理、心理、社會及靈性等層面進行整體性的評估，確立病人有組織完整性受損、口腔黏膜改變及身體心像改變之健康問題。藉由科學依據之護理措施監測皮瓣血循以維護良好血循，以不含酒精之酵素漱口水配合口腔清潔措施，促進口腔黏膜癒合，並與病人及家屬建立信任護病關係，引導抒發對於外觀及功能改變內心感受，透過類似經驗病友分享心路歷程，逐漸接受身體外觀變化，轉而能正向肯定自我生命價值。期盼藉由此次護理經驗，做為日後臨床照護年輕女性罹患口腔癌病人之參考。

This article presents the nursing experience of a 23-year-old female with oral cancer who received oral tumor wide excision and flap reconstructive surgery, and the physiological and psychological impact on the patient after undergoing three successive operations. The duration of care was from 15th to 20th June in 2018. Data was collected by observation, interview, physical assessment, and chart review. The patient's health problems were identified, including impaired tissue integrity, oral mucosa change, and disturbed body image by conducting holistic assessment. We used an evidence-based method to monitor and maintain good perfusion of the flap, and applied enzyme mouthwash with and oral cleaning method to stimulate the healing of oral mucosa. We also established a trusted nurse-patient relationship with the patient and her family and guided the patient to express her feelings toward the change of her appearance and function, and at the same time, shared psychological struggles of patients with similar problems so that she could gradually accept the change of her body and empower her self-worth. By sharing this nursing experience, we hope to provide a reference for caring for young female patients with oral cancer.