一位舌癌患者氣切術後之照護經驗

The Experience of Caring for a Patient with Tongue Cancer after Tracheostomy

10.6880/TJON.202112_21(2).06

郭怡君(Yi-Chun Kuo)；吳麗娟(Li-Chuan Wu)；林家溱(Chia-Chen Lin)

舌癌 ； 腫瘤傷口照護 ； 社交隔離 ； tongue cancer ； tumor wound care ； social isolation

腫瘤護理雜誌

21卷2期（2021 / 12 / 01）

67 - 77

繁體中文

本文探討一位女性舌癌患者因腫瘤壓迫呼吸道，行氣切術後之照護經驗。照護期間自2018年11月09日至11月19日，運用羅氏適應模式進行評估，透過身體評估、筆談及病歷查閱等方式收集資料，確立個案健康問題有呼吸道清除功能失效、組織完整性受損及社交隔離。本個案於術後初期對於氣切造口感到相當不適應，除外貌改變，亦影響溝通表達方式，因此產生人際內縮現象。筆者在照護過程中，除了加強陪伴及關懷、與個案建立治療性人際關係，更運用跨團隊合作，改善腫瘤惡臭、病友團體介入，強化人際互動，以增強自信心。使用多媒體衛教及實際反覆技術操作，引導個案及案夫調適生心理的變化，並提升自我照護能力。期望藉此照護經驗提供臨床護理人員，如何因應及協助患者在氣切術後所面臨的生、心理壓力，以全人照護的概念，增加個案生心靈健康及社會適應能力，進而提升舌癌患者的照護品質。

This article explores the nursing care of a female tongue cancer patient who underwent airway resection for tumor compression. During the period of care from November 09 to November 19, 2018 the author performed nursing assessments using the Roy Adaptation Model, collected data via physical assessment, conversation by writing, and chart review to identify the major health issues, which were: ineffective airway clearance, impaired tissue integrity and social isolation. The patient was quite uncomfortable from the tracheostomy in the early postoperative period. In addition to the appearance change, the vocal expression was impacted as well, both of which caused social isolation. In the process of care, the author not only strengthened companionship and care, established therapeutic interpersonal relationships with the patient, but also used cross-team collaborations to control tumor odor and involved patient groups to strengthen interpersonal interaction and confidence. Multimedia and repeated in-person skill training were also used to guide patient and patient's husband to adjust to the psychological changes and improve self-care. It's hope that this article can provide nursing staff with the nursing care experience on how to respond to and assist patients in the physical and psychological stress after tracheotomy, and use the concept of whole person care to improve the mental health and build social adaptability to improve the quality of care for patients with tongue cancer.

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