照護一位口腔癌病患手術後成功脫離呼吸器之護理經驗

A Nursing Experience of Weaning the Ventilator for a Patient with Oral Cancer After Surgery

10.6974/TCNJ.201202.0101

吳雅紋(Ya-Wen Wu)；梁惠玉(Hui-Yu Liang)

口腔癌 ； 脫離呼吸器 ； 氣切發聲閥 ； oral cancer ； speaking valves ； ventilator weaning

志為護理-慈濟護理雜誌

11卷1期（2012 / 02 / 01）

97 - 108

繁體中文

本篇文章旨在探討一位罹患口腔癌術後呼吸器依賴，面臨多次脫離失敗衝擊之護理經驗。護理期間自2009年10月29日至11月20日，以Gordon十一項健康功能型態評估架構，經由觀察、紙筆溝通及家屬訪談等方式收集資料，確立健康問題有：呼吸機戒斷反應功能失常與呼吸肌肉無力有關；焦慮與呼吸器脫離失敗及無法有效的溝通有關；潛在危險性感染與手術後傷口及血糖控制不佳有關。護理過程中鼓勵病人及家屬參與呼吸訓練計劃，予適時的陪伴、肯定，使個案對呼吸器脫離有正向的態度；提供氣切發聲閥提升溝通能力增加自信心，降低焦慮而成功脫離呼吸器；以無菌技術執行傷口護理，調整飲食控制血糖，預防感染的發生。期望藉此個案照護經驗能提供未來對口腔癌術後呼吸器脫離病患照護上參考。（志為護理，2012；11：1，97－108）

This article aimed to describe a nursing experience of weaning the ventilator from an oral cancer patient after the surgery. The period of nursing care was from October 29th to November 20th, 2009. Gordon’s eleven functional health assessments were applied, and data were collected through observation, interview and communications. The major problems identified were: dysfunctional ventilator weaning response related to retained secretion and three prior weaning failures; risk for potential infection related with post operation wound and diabetes; altered body image related anxiety and social loss. The following measures were implemented as result: aseptic techniques for wound care, diet adjustment in order to control blood sugar and prevent infection; encourage family participation in treatment and respiratory care team training program, leading to the successful weaning from the ventilator; provide speaking valves to increase patient’s communication skills; and positive encouragement on the patient to face therapy process and decrease anxiety. We expect this nursing experience to provide a reference for ventilator weaning in future care of oral cancer patient after surgery.(Tzu Chi Nursing Journal, 2012; 11:1, 97-108)