一位壯年男性初次罹患舌癌之術後護理經驗

The Postoperative Nursing Experience of a Middle-Aged Patient with a Newly Diagnosed Tongue Cancer

10.6692/KJN.202404_41(1).0011

王靜婷(Jing-Ting Wang)；吳珮菁(Pei-Ching Wu)

舌癌 ； 急性疼痛 ； 吞嚥障礙 ； Tongue cancer ； Acute pain ； Impaired swallowing

高雄護理雜誌

41卷1期（2024 / 04 / 01）

135 - 146

繁體中文;英文

本文為探討一位壯年男性初次罹患舌癌之術後護理經驗。照護期間為2020年3月28日～3月30日、2020年4月2日～4月23日，以Gordon十一項健康功能性評估及身體評估、觀察、會談、臨床照護、病歷查閱等方式，確立健康問題為急性疼痛、焦慮、吞嚥障礙；照護過程分別於白晝，提供採光適宜及寧靜環境，降低明亮光線及吵雜聲響，減少刺激誘發疼痛；使用重量約185g 12吋電子手寫板（Liquid-Crystal Display，LCD），方便抓取及表達心中焦慮；運用跨專業領域評估，以精油及配合穴位按摩，達到嗅覺及觸覺雙重感受進而達到放鬆，減輕焦慮不安情緒；利用舌部復健及下載國際吞嚥困難飲食標準（The International Dysphagia Diet Standardization Initiative，IDDSI）QR code，讓訓練吞嚥時的各階段，方便查詢不同需求的飲食，以改善吞嚥障礙；期望以此照護經驗能提升舌癌病人術後之生活品質。

This article details the postoperative nursing experience of a middle-aged man suffering from tongue cancer. Nursing care was provided from March 28 to March 20, 2020; April 2 to April 23, 2020.Lighting and quiet environments to reduce the stimulation from light and noises to avoid pain evoking. We let the patient use a 185 gram, 12-inch LCD writing tablet, which is convenient to grasp, for expressing his anxiety. We also applied interdisciplinary assessment such as massaging with essential oil and acupressure for relaxing and reducing anxiety through the sense of both smelling and touching. Tongue rehabilitation was arranged for improving dysphagia. The patient could search for the proper diet choices for different phases of training of swallowing the swallowing IDDSI QR code.

1. 相青琪、胡月娟（2017）．口腔護理計劃對口腔癌術後患者吞嚥功能的影響．護理雜誌，64（2），88-98。https://doi.org/10.6224/JN.000027
   連結：
2. 陳芷萱、劉睿菁（2019）．吞嚥困難知多少．彰基醫療健康防治季刊，38，29-30。https://doi.org/10.6527/PVMN.201912_(38).0010
   連結：
3. 陳麗麗、林君黛（2015）．穴位按壓與實證護理．護理雜誌，62（6），27-34。https://doi.org/10.6224/JN.62.6.27
   連結：
4. 戴月明、楊斯年（2019）．癌症病人之創傷後壓力症、憂鬱及自殺風險．源遠護理，13（2），5-8。http://doi.org/10.6530/YYN¬.201907-_13(2).0001
   連結：
5. Abati, S. Bramati, C. Bondi, S. Lissoni, A. & Trimarchi, M. (2020). Oral cancer and precancer: A narrative review on the relevance of early diagnosis. International Journal of Environmental Research and Public Health, 17(24), 9160. https://doi.org/ 10.3390/ijerph17249160
   連結：
6. Chandu, A. Smith, A. C. H., & Rogers, S. N. (2006). Health-related quality of life in oral cancer: A review. Journal of Oral and Maxillofacial Surgery, 64(3), 495-502. https://doi.org/10.1016/j.joms.2005.11.028
   連結：
7. Salvo, E. Campana, W. M., Scheff, N. N., Nguyen, T. H., Jeong, S-h. Wall, I. Wu, A. K., Zhang, S. Kim, H. Bhattacharya, A. Janal, M. N., Liu, C. Albertson, D. G., Schmidt, B. L., Dolan, J. C., Schmidt, R. E., Boada, M. D., & Ye, Y. (2020). Peripheral nerve injury and sensitization underlie pain associated with oral cancer perineural invasion. Pain, 161(11), 2592-2602. https://doi.org/10.1097/j.pain.0000000000001986
   連結：
8. Schouten, B., Avau, B., Bekkering, G., Vankrunkelsven, P., Mebis, J., Hellings, J., & Hecke, A. V. (2019). Systematic Screening and Assessment of Psychosocial Well-Being and Care Needs of People with Cancer. The Cochrane Database of SystematicRreviews, 3(3), CD012387. https://doi.org/10.1002/14651858.CD012387.pub2
   連結：
9. Wang, T. F., Li, Y. J., Chen, L. C., Chou, C. & Yang, S. C. (2020). Correlation between postoperative health-related quality of life and care needs of oral cancer patients. Cancer Nursing, 43(1), 12-21. https://doi.org/10.1097/NCC.0000000000000677
   連結：
10. 胡月娟、郭炯村、江青桂、陳瑋、陳蕙玲、林武佐、張琪、何玉雲、陳玉葉、劉曉菁、呂哲維、陳秋珍、林至德（2019）．進食、吞嚥困難照護及指導方案指引手冊。https://www.mohw.gov.tw/dl-58240-7db4bf9c5cc7-430a-841e-1760d967e21b.html
11. 黃玉琪、吳碧雲、蕭思美（2017）．疼痛病人之護理．於胡月娟總校閱，內外科護理學上冊（五版，119-125頁）．華杏。
12. 衛生福利部統計處（2022，6月30日）．109年國人死因統計結果。https://www.mohw.gov.tw/cp-16-70314-1.html
13. Gonzalez, M. & March, A. R. (2023). Tongue Cancer. https://www.ncbi.nlm.nih.gov/books/NBK562324/
14. Werner, M. & Braunschweig, R. V. (2015). 芳香療法實證學．（李文媛、蔡慈皙、葛偉芬譯；暢銷精裝版）．德芳學院。（原著出版於2005）