照護一位舌癌術後首次接受放射線治療病人之護理經驗

Nursing Experience of a Patient with Tongue Cancer Receiving First Postoperative Radiation Therapy

10.3966/168395442015061501006

陳敏如(Min-Ru Chen)；陳淑卿(Shu-Ching Chen)；賴裕和(Yeur-Hur Lai)；江嘉琪(Chia-Chi Jiang)；謝雪貞(Shiue-Jen Shie)；陳姝年(Chu-Nien Chen)

舌癌 ； 術後 ； 放射線治療 ； tongue cancer ； postoperative ； radiation

腫瘤護理雜誌

15卷1期（2015 / 06 / 01）

47 - 58

繁體中文

台灣地區口腔癌發生率節節上升，而在口腔癌中，舌癌佔第一位。本文探討一位罹患舌癌手術治療後，接受首次放射線治療病人的護理經驗。筆者於2014年2月25日至2014年4月3日藉由直接的照護、觀察與持續的會談及身體評估進行資料收集，運用羅氏適應模式做為評估指引，確立病人的健康問題有吞嚥困難、口腔黏膜改變及相關知識缺失。護理過程中提供吞嚥訓練照護、口腔護理與個別化的護理指導，協助病患在放射線治療期間獲得足夠的照護及擁有良好的生活品質，並學習面對疾病及執行自我的居家照護。期望本文可以做為臨床照護舌癌接受放射線治療病人的護理參考。

In Taiwan the incidence of oral cancer, with tongue cancer being the major occurrence, is on a constant rise. This article describes the nursing experience of a tongue cancer patient on his first postoperative radiation therapy. All data were collected through firsthand patient care, observation, frequent dialogues, and physical examination from February 25, 2014 to April 3, 2014. The Roy's Adaptation theory was used as assessment guide to identify patient's healthcare problems, such as: difficulty swallowing, impaired oral mucosa membrane, and lack of related knowledge. The nursing process provided swallow training, oral care, and individualized nursing instruction to help patient receive adequate nursing care and achieve better quality of life during the radiation therapy; patient was also encouraged to learn to face the disease and implement self care at home. It is hoped this article can be used as a clinical care reference for the nursing of tongue cancer patients under radiation therapy.

1. Chen, S. C.,Lai, Y. H.,Liao, C. T.,Chang, J. T.,Lin, C. Y.,Fan, K. H.,Huang, B. S.(2013).Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy.Psychooncology,22(6),1220-1228.
2. de Leeuw, J.,van den Berg, M. G.,van Achterberg, T.,Merkx, M. A.(2013).Supportive care in early rehabilitation for advanced-stage radiated head and neck cancer patients.Otolaryngol Head Neck Surgery,148(4),625-632.
3. Dirix, P.,Nuyts, S.,Van den Bogaert, W.(2006).Radiation-induced xerostomia in patients with head and neck cancer: A literature review.Cancer,107(11),2525-2534.
4. Glenny, A. M.,Gibson, F.,Auld, E.,Coulson, S.,Clarkson, J. E.,Craig, J. V.(2010).The development of evidence-based guidelines on mouth care for children, teenagers and young adults treated for cancer.European Journal of Cancer,46(8),1399-1412.
5. Heymann, W. R.(2009).Carcinoma of the tongue.Journal of the American Academy of Dermatology,60(5),838-840.
6. Meulen, I. C.,Leeuw, J. R. J.,Gamel, C. J.,Hafsteinsdottir, T. B.(2013).Educational intervention for patients with head and neck cancer in the discharge phase.European Journal of Oncology Nursing,17,220-227.
7. Selen, S.(2013).Head and Neck Cancer: Changes in artrokinematic parameters of neck and swallowing function after radiotherapy.International Journal of Hematology and Oncology,97-103.
8. van den Brink, J. L.,Moorman, P. W.,de Boer, M. F.,Pruyn, J. F.,Verwoerd, C. D.,van Bemmel, J. H.(2005).Involving the patient: A prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care.International Journal of Medical Informatics,74(10),839-849.
9. 田沁潔, C. C.,賴惠玲, L. L.,許文林, W. L.,彭逸稘, Y. C.,李茹萍, R. P.(2007)。護理指導對頭頸部癌症病人口腔照顧認知、健康信念及自我效能之成效。實證護理，3(3)，215-224。
10. 李怡珍, Y. C.,顏欽堉, C. Y.,林玟吟, M. Y.,于錫倩, H. C.,張敏德, M. T.(2014)。探討口腔癌術後早期介入吞嚥訓練及監測進食安全之成效及影響因素。台灣口腔顎面學會雜誌，25，1-7。
11. 周繡玲, H. L.,謝嘉芬, C. F.,李佳諭, C. Y.,江孟冠, M. G.,紀雯真, W. C.(2010)。癌症病人口腔黏膜炎臨床照護指引。腫瘤護理雜誌，11，61-85。
12. 林雅婷, Y. T.,唐秀治, S. T.(2010)。頭頸部癌症病人接受放射線治療後口腔合併症之嚴重度變化。源遠護理，4(2)，34-41。
13. 陳妙言, M. Y.,林麗嬋, L. C.(2010)。吞嚥障礙之概念分析。護理雜誌，57(1)，100-105。
14. 衛生福利部（2013，6月6日）．101年十大死因統計，2014年5月取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2746 [Department of Health, Executive Yuan, R.O.C. (Taiwan) (2013, June 6). Deaths in Taiwan, 2012. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2746]
15. 謝麗鳳, L. F.,莊紫雲, T. Y.,劉淑珍, S. C.,蔡欣玲, S. L.,陳美碧, M. B.(2011)。癌症病人化療期間居家護理指導及電話諮詢成效。腫瘤護理雜誌，11(1)，23-35。