照護一位口腔癌術後接受化放療治療個案之護理經驗

Nursing Experience of a Patient with Oral Cavity Cancer Receiving Postoperative Concurrent Chemoradiotherapy

蔡佩芳(Pei-Fang Tsai)；林淑琴(Shu-Chin Lin)

口腔癌 ； 疼痛 ； 身體心像改變 ； Oral cavity cancer ； pain ； body image disturbance

若瑟醫護雜誌

11卷1期（2017 / 04 / 01）

140 - 151

繁體中文

本文主要探討一位口腔癌病患術後同步接受化放療之護理經驗。個案因手術造成顏面缺損導致臉部外觀改變，張口、進食、說話等功能受到影響，致使情緒低落嚴重影響生活品質。筆者在2014 年7 月14 日至8 月28日，藉由與個案、家屬會談、觀察、直接護理方式收集資料，採用Gorden十一項功能性健康型態為評估工具，確立個案有口腔黏膜改變、疼痛與身體心像紊亂等護理問題。照護期間與個案建立良好之治療性關係，運用臨床護理知識技能，主動關懷及持續性照護，指導個案日常生活自我照顧技巧，引導個案表達術後身體心像改變之感受，加強家人的支持與陪伴；鼓勵參加頭頸癌病友會以增加其支持系統，使個案正向面對術後身體外觀的改變，積極適應新的生活。藉此經驗分享，提供護理人員對於口腔癌病患術後生理心理的改變有更深切的認識，適時提供完整的護理計劃與衛教指導，以提升照護品質。

This article describes the nursing experience of an oral cavity cancer patient on his postoperative chemoradiotherapy. Because of the surgery, the patient experienced changes in facial look; impaired mouth opening as well as impaired intake and speech functions. All the above depressed the patient and altered his quality of life severely. Data was collected through interview with the patient and his family, observation, and firsthand patient care from July 14, 2014 to Aug 28, 2014. Gordon 11 function health patterns are utilized to identify the patient's health care problems, including oral mucosa change, pain and disturbed body image. By providing the patient proactive and continued care, caring him with clinical nursing skills, we established good therapeutic relationship with the patient. We taught him self-care skills for daily life, guided him to express his feeling after the body-image change, enhanced support and company from the family, and encouraged him to attend head and neck cancer survivor alliance to strengthen his support systems. He can now face his body-image change with a positive attitude and adapt a whole new life aggressively. This nursing experience to provide more information about the psycho-physiological change in oral cavity cancer patients who received surgery, and to provide integrated nursing care plan and throughout patient education to facilitate nursing care quality.

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