一位食道癌個案首次行氣管及空腸造口術之護理經驗

A Nursing Experience of a First-time Tracheostomy and Jejunostomy Operation for Esophageal cancer

10.6692/KJN.202408_41(2).0012

曾鈺評(Yu-Ping Tseng)；吳儀君(Yi-Jun Wu)；黃弘暄(Hong-Syuan Huang)

食道癌 ； 呼吸道清除功能失效 ； 身體心像紊亂 ； 增進家庭因應能力的準備度 ； esophageal cancer ； ineffective airway clearance ； body image disturbance ； readiness for enhanced family coping

高雄護理雜誌

41卷2期（2024 / 08 / 01）

130 - 140

繁體中文;英文

本文探討一位診斷食道癌63歲男性，因腫瘤壓迫食道導致困難進食、嚴重營養不足以及腫瘤壓迫氣管以致呼吸困難，故入院行氣管及空腸造口術。因首次管路留置產生的身心靈衝擊，以及照顧者面臨出院後的返家照護。筆者於2021年6月13日至7月8日護理期間，以觀察、筆談、身體評估及查閱病歷方式收集資料，運用Gordon十一項健康功能評估，確立個案的主要護理問題有：「呼吸道清除功能失效」、「身體心像紊亂」及「增進家庭因應能力的準備度」。利用教導肺復原運動，使個案自行清除呼吸道分泌物，給予傾聽及陪伴，藉由家庭支持力量幫助個案適應外觀改變、也提供適宜的出院衛教提升家庭能力的準備度，期盼藉此照護經驗分享，可供日後照護此類病人做參考。

A 63-year-old man diagnosed with esophageal cancer was admitted to the hospital for tracheostomy and jejunostomy due to the tumor compression of the esophagus and the trachea. The patient still has the physical and emotional impact of the first tube indwelling, and the caregiver also needs to face home care after discharge. During the nursing period from June 13 to July 8, 2021, the author collected data through observation, written communication, physical assessments, and medical records. Using Gordon's 11 health function assessments, the main nursing problems of the cases were identified as "ineffective airway clearance", "disturbed body image" and "readiness for enhanced family coping". We taught patients pulmonary rehabilitation to clear sputum by themselves, listened to and accompanied them, helped them adapt to the changes in appearance through family support, and also provided them with appropriate discharge education to enhance family coping. We hope that this nursing experience can be used as reference material for the future care of such patients.

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