照護頸部血管瘤病人面對氣切衝擊之加護經驗

Nursing Care Experience of a Patient with Nuchal Hemangioma Suffering from the Negative Impacts of Tracheostomy at the Intensive Unit

10.6740/NTUHJN.201801_14(1).0009

顧婉鈺(Wan-Yu Ku)；莊寶玉(Pao-yu Chung)

血管瘤 ； 氣切 ； 身體心像 ； hemangioma ； tracheostomy ； body image

臺大護理雜誌

14卷1期（2018 / 01 / 01）

79 - 91

繁體中文

本文探討一位被診斷為血管瘤之年輕男性，面對疾病造成心理的衝擊及對治療過程不確定感，且因腫瘤壓迫呼吸道需行氣切手術而造成身體心像改變的心理衝擊之護理經驗。於2015/3/02至3/22護理期間藉由臨床照護過程，觀察、紙筆溝通及身體評估等技巧蒐集資料，以Gordon 11項健康功能型態進行整體性評估，確立個案健康問題包含呼吸道清除功能失效、疼痛、焦慮及身體心像改變。透過個別護理指導，衛教疾病治療相關知識，減輕對疾病及治療過程的焦慮，降低手術後傷口疼痛，維持手術後呼吸道通暢及減少肺部合併症產生。經由陪伴，運用接納、同理、鼓勵技巧，激發自我照顧能力，提升自信心及自我價值感，使個案最後願意坦然接受疾病及面對術後身體心像改變，並重建信心勇敢面對未來生活。建議照顧此類個案除了維持呼吸道通暢外，提供個案心理支持與協助認知及接納外觀的改變，將有助個案克服疾病的負面影響與身心壓力，進而自我調適，接受改變後的自我。

This article discussed the nursing care experiences of a young man newly diagnosed with nuchal hemangioma and suffering from the negative psychological impacts of the disease. He felt uncertainty about the treatment process, and experienced the changes of body image after tracheostomy for managing airway obstruction due to hemangioma. Nursing care was applied from 2 to 22 March 2015. Based on Gordon's 11 Functional Health Patterns, the nurse assessed the patient's problems by administering direct nursing care, taking observations, written communication, and conducting a physical examination. The ineffective airway clearance, pain, anxiety, and body image changes were identified as the main health problems. Through individualized nursing education, the patient learned about the disease and treatments to reduce his anxiety. Moreover, nursing cares aimed to reduce pain due to the wound, maintain airway clearance, and reduce pulmonary complications after the operation. Nursing care skills of acceptance, empathy, and encouragement improved the patient's self-care capacity, confidence, and self-worth. Finally, the patient accepted the disease, and the changes of body image and gained the courage to face the future life challenges. In caring for this type of patient, we suggest that besides maintaining airway clearance, nursing cares should include psychological support, to help the patients overcome the negative psychological impacts, body-mind stress and finally to establish the ability of self-adjustment.

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