一位復發性甲狀腺癌患者之護理經驗

Nursing Experience of a Patient with Recurrent Thyroid Cancer

本文旨在探討一位甲狀腺癌復發患者，因腫瘤壓迫呼吸道及食道須接受氣管切開術，個案除了面臨癌症復發衝擊外，術後因無法接受身體心像改變及不知如何利用氣切造口及鼻胃管學習新的生存技巧，導致個案感到挫敗。筆者於護理期間利用紙筆與個案進行溝通外並與主要照顧者進行會談，運用Gordon十一項健康功能型態評估，確認個案主要護理問題有急性疼痛、焦慮、身體心像改變及家庭運作過程紊亂。護理期間維持生理舒適，建立良好護病關係，告知疾病治療相關認知、給予勵志小卡、教導以筆談及肢體語言方式溝通，經由個別性衛教指導學習新的生存技巧，最後協助個案重新恢復價值信念及增強自尊，減低焦慮情緒及生活品質的提升。This article described the nursing experience of a recurrent thyroid cancer patient who received tracheostomy due to upper airway compressed by the tumor. During the hospitalization, the patient not only suffered from the impacts of getting cancer but also was frustrated with the change of his body image and renewal of daily tracheostomy and nasogastric tube management. In the period of caring, the author communicated with the patient by writing and with his caregivers by interviews. In addition, the author applied the eleven functional health patterns described by Gordon to evaluate and identify the patient's major problems, including acute pain, anxiety, change in body image and familial psychosocial disturbance. During the period of nursing care, not only the maintenance of physical comfort but also the establishment of a good interpersonal relationship and realization of the correct treatment of disease were given. In addition, inspirational cards and body language were used. By guiding patient instructions, the patient mastered the processes of caring the tracheotomy tube and nasogastric tube. Finally, we helped the patient to revive his values of life, to strengthen his self-esteem, to overcome the anxious emotions and to promote the quality of life.