一位齒齦癌個案接受同步化放射療之護理經驗

The Nursing Experience of a Patient with Gingival Cancer Receiving Concurrent Chemoradiotherapy

10.6880/TJON.202112/SP_21.01

林沛儀(Pei-Yee Lin)；曾怡菱(Yi-Ling Tseng)

齒齦癌 ； 同步化學放射線治療 ； 口腔黏膜障礙 ； 嗜中性白血球低下 ； 放射線皮膚炎 ； gingival cancer ； concurrent chemoradiotherapy ； impaired oral mucous membrane ； neutropenia ； radiation dermatitis

腫瘤護理雜誌

21卷增訂刊II（2021 / 12 / 01）

5 - 17

繁體中文

本文個案為因口腔黏膜破損、疼痛及張口困難超過兩週，初次診斷為左下齒齦癌之病人。照護期間自2019年4月16日至2019年4月27日，因個案多次表示對口腔黏膜破損感到不適，且主要照顧者擔心無法應付治療後的各種副作用，故引發筆者探討的動機，經Gordon十一項功能性健康型態評估後，擬定口腔黏膜完整性受損、知識增進準備度與潛在危險性感染等三項健康問題之護理計畫，給予並教導口腔護理、口腔復健運動、傷口照護技巧以及預防感染之照護措施，達到口腔黏膜損傷無擴大或感染，增進個案及主要照顧者對同步化放療照顧認知與技能之目標。照護期間，筆者以衛教單張輔助多媒體影片提供衛生教育，個案在出院前表示，能及時獲得口腔護理及癌症治療相關知識，有信心渡過癌症治療中的不適，希望藉由此護理經驗分享，提供護理人員在照護接受化放療之癌症病人及其主要照顧者護理指導之參考。

This article describes the nursing care, from April 16 to April 27 of 2019, of a patient with gingival cancer who suffered from oral mucosal damage, pain, and difficult mouth movement. During the two-week period of the nursing care, patient expressed discomfort related to oral mucosal damage and his caregiver also expressed concerns about the side effects from the concurrent chemoradiotherapy, which led to the conception of this paper. The author first identified the three main health issues of this patient, which were (1) the impaired oral mucous membrane, (2) readiness for enhanced knowledge, and (3) risk of infection by using the Gordon's 11 Functional Health Patterns Assessment; and the author executed related nursing plans including the teaching of oral care, oral exercise, wound care and infection prevention measures with an aim to achieve infection-free oral mucosal damage control and to improve the patient and caregiver's knowledge and caring skills on concurrent chemoradiotherapy. With the health education provided through the health education manuals and multimedia videos, the patient was able to fully obtain the nursing skills and related knowledge of concurrent chemoradiotherapy in a timely fashion before discharge. Patient expressed he was empowered with enough confidence to go through the course of cancer treatment. The author hope this nursing experience could serve as a useful reference to the clinical nursing care guidelines for cancer patients receiving concurrent chemoradiotherapy and also for the main caregivers.

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