题名

照護一位初次診斷口腔癌病人術後照護經驗

并列篇名

Experience Caring for a Patient with Recently Diagnosed Oral Cancer after Surgery

DOI

10.6647/CN.202409_31(3).0012

作者

王奕琦(Yi-Chi Wang);陳玟蓉(Wen-Jung Chen);陳美如(Mei-Ju Chen)

关键词

口腔癌 ; 皮瓣重建 ; 身體心像改變 ; oral cancer ; flap reconstruction ; disturbed body image

期刊名称

彰化護理

卷期/出版年月

31卷3期(2024 / 09 / 01)

页次

103 - 116

内容语文

繁體中文;英文

中文摘要

本文主要探討一位56歲男性個案初次診斷口腔癌行皮瓣重建手術之全期護理照護經驗,手術後因身體外觀改變造成身、心理上影響。護理期間自2022年5月12日至5月28日,筆者藉由觀察、溝通、身體評估、會談等方式蒐集個案資料,以Gordon十一項功能性健康型態架構為評估工具,確定個案有疼痛、呼吸道清除功能失效及身體心像改變之護理問題。護理過程提供藥物及放鬆技巧來緩解疼痛;主動給予陪伴及關懷,建立彼此良好的護病關係,提供個案個別性的護理措施;使用噴霧治療及胸腔物理治療,協助痰液排出以減少不適感;協助個案調適身心狀態面對身體外觀改變,與疾病所帶來的壓力,重建個案自我心像之完整。當病人身體心像改變造成壓力無法有效處理時,易產生無助感及焦慮,導致建立護病關係上的困難,應特別注意個案心理層面產生的問題,協助他們面對外觀改變上的正向態度,也建議可製作手術全期影片,讓病人及家屬可以清楚了解到手術治療全期可能面臨的相關問題,減少其徬徨、忐忑情緒,使其能順利出院,針對重建手術後病人建檔追蹤,了解居家照護狀況,以提升或改善居家照護品質。希望藉此照護經驗,提供醫護人員在照護口腔癌重建病人上之參考,以提升照護品質。

英文摘要

This article discusses the nursing experience of a 56-year-old male patient who underwent an oral cancer diagnosis and skin flap reconstruction surgery. After the surgery, the patient experienced physical and psychological effects due to changes in his appearance. During the nursing period from May 12, 2022 to May 28, 2022, we collected case data through observation, communication, physical assessment, and interviews, using Gordon's Eleven Functional Health Patterns as an assessment tool. Nursing problems identified in the case included pain, ineffective airway clearance, and changes in body image. Medication and relaxation techniques were provided to alleviate pain. Active companionship and care were given to establish a good nurse- patient relationship, and individualized nursing measures were provided. Spray therapy and chest physiotherapy were used to help clear secretions and reduce discomfort. The physical and mental state of the patient was attended to due to changes in appearance and stress brought about by the illness. Patients who develop physical and psychological changes that cause stress may develop feelings of helplessness and anxiety, making it difficult to establish a caregiving relationship. Particular attention should be paid to the psychological issues that arise in individual cases, and efforts should be made to assist these patients in adopting a positive attitude toward changes in their appearance. We recommend creating a video of the entire surgical period so that patients and their families clearly understand the relevant issues facing them during surgery, which will reduce confusion and anxiety and help them discharge smoothly. Follow-up records should be kept for patients who have undergone reconstructive surgery to understand and improve the quality of their home care. We hope to provide a reference for healthcare professionals in caring for patients undergoing reconstruction for oral cancer to improve the quality of care.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. 李和惠、林麗秋、胡月娟、黃玉琪.吳碧雲、蕭思美、楊婉萍、江令君、林貴滿、林靜琪、許譯瑛、謝春滿、杜玲、陳秀勤、劉清華、郭淑芬、李崇仁、蔡麗絲、張珠玲、......、柯薰貴(2019)•呼吸系統疾病病人之護理.胡月娟總校閱•內外科護理(上冊,八版,1131-1172 頁)•華杏。
    連結:
  2. 姜亭妤、簡淑慧、徐鴻智、陳淑卿(2018)•心理調節措施在癌症患者身體心像改變及情緒困擾之成效-系統性文獻回顧•長庚護理,29 (3),350-366。http://doi.org/10.6386/CGN.201809_29(3).0003
    連結:
  3. 陳蕙君、謝春金、陳麗鳳(2017)•一位年輕男性口腔癌術後個案面臨身體心像改變之護理經驗•領導護理,18 (1),21-33。http://10.29494/LN.201703_18(1).0003
    連結:
  4. 曾佳敏、歐索妃(2017)•一位口腔癌病人於皮瓣重建術後面臨疾病不確定感之照護•高雄護理雜誌,34(2),121-132。https://doi.org/10.6692/KJN-2017-34-2-11
    連結:
  5. 蔡佩芳、林淑琴(2017)•照護一位口腔癌術後接受化放療治療個案之護理經驗•若瑟醫護雜誌,11(1),140-151。http://dx.doi.org/10.30145/STJHMNJ
    連結:
  6. 顧婉鈺、莊寶玉(2018)•照護頸部血管瘤病人面對氣切衝擊之加護經驗•台大護理雜誌,14(1),79-91。https://doi.org/10.6740/NTUHJN.201801_14(1).0009
    連結:
  7. Arakeri, G., Patil, S. G., Aljabab, A.S., Lin K. C., Merkx, M. A. W., Gao, S., & Brennan, P. A. (2017). Oral submucous fibrosis: an update on pathophysiology of malignant transformation. Journal of Oral Pathology & Medicine, 46(6), 413–417. https://doi.org/10.1111/jop.12582
    連結:
  8. Da-Silva, L. F. M., Pascoal, L. M., Nunes, S. F. L., de Sousa Freire, V. E. C., de Araújo Almeida, A. G., Gontijo, P. V. C., & Neto, M. S. (2019). Ineffective airway clearance in surgical patients: Evaluation of nursing interventions and outcomes. International Journal of Nursing Knowledge, 30(4), 251–256. https://www.doi.org/10.1111/2047-3095.12242
    連結:
  9. Gonzalez, M. & March, A. R. (2023). Tongue Cancer. https://www.ncbi.nlm.nih.gov/books/NBK562324/
    連結:
  10. Koyfman, S., Joshi, N. P., Lamarre, E., Tsai, C. J., Schymick,M. A., Liu, H., & Tam, L., Rybicki, L., Dunlap, N. E., Porceddu, S., Ghanem, A. I., Siddiqui, F., Caudell, J. J., Lee, N., Geiger, J. L., Burkey, B. B., Adelstein, D. J., & Woody, N. M. (2018). Validating the AJCC 8th Edition of the Oral Cavity Cancer Staging System: A Multi-institutional Collaborative Study. International Journal of Radiation Oncology, Biology, Physics, 102(3), Article S22. https://www.doi.org/10.1016/j.ijrobp.2018.06.141
    連結:
  11. Kumar, M., Nanavati, R., Modi, T. G., Dobariya, C. (2016). Oral cancer: tiology and risk factors: A review. Journal of cancer research and therapeutics, 12(2), 458-463. https://doi.org/10.4103/0973-1482.186696
    連結:
  12. Naurecka, M. L., Sierakowski, B. M., Kasprzycka, W., Dojs, A., Dojs, M., Suszyński, Z., & Kwaśny, M. (2017). FTIR-ATR and FT-Raman Spectroscopy for Biochemical Changes in oral tissue. American Journal of Analytical Chemistry, 8(3), 180-188. https://doi.org/10.4236/ajac.2017.83015
    連結:
  13. Shunmuga, S. C., Dhillon, H. M., Butow, P. N., Sundaresan, P., & Rutherford, C. (2019). A systematic review of body image measures for people diagnosed with head and neck cancer (HNC). Supportive Care in Cancer, 27(10), 3657-3666. https://www.doi.org/10.1007/s00520-019-04919-6
    連結:
  14. Tamai, N., & Mugita, Y., & Ikeda, Ma., & Sanada, H. (2016). The relationship between malignant wound status and pain in breast cancer patients. European Journal of Oncology Nursing, 24, 8-12. https://www.doi.org/10.1016/j.ejon.2016.05.004
    連結:
  15. Tandler, S., & Stephen-Haynes, J. (2017). Fungating wounds: management and treatment options. British Journal of Nursing,26(12), S6-14. https://www.doi.org/10.12968/bjon.2017.26.12.S6
    連結:
  16. Yue, J., Zhuo, S., Zhang, H., Liu, X., & Zhang, W. (2018). Long-term quality of life measured by the University of Washington QoL questionnaire (version 4) in patients with oral cancer treated with or without reconstruction with a microvascular free flap. The British journal of oral & maxillofacial surgery, 56(6), 475-481. https://doi.org/10.1016/j.bjoms.2017.12.017
    連結:
  17. 衛生福利部(2024)•112年國人死因統計結果,取自https://www.mohw.gov.tw/cp-16-79055-1.html
  18. 衛生福利部國民健康署(2024a,4月25日)•口腔癌防治,取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=613&pid=1118
  19. 衛生福利部國民健康署(2024b)•癌症病友服務,取自https://www.hpa.gov.tw/Pages/List.aspx?nodeid=448
  20. National Comprehensive Cancer Network (2024). Guidelines:Head and Neck Cancers. https://www.nccn.org/professionals/physician_gls/default.aspx