一位口腔癌患者接受皮瓣重建術之護理經驗

A Nursing Experience of an Oral Cancer Patient Receiving Flap Reconstruction

本文敘述一位55歲男性患者，因口腔癌接受皮瓣重建術，護理期間自2012/9/1至9/18止，運用Gordon十一項功能性健康型態評估收集資料，確立護理問題有急性疼痛、組織完整性受損、呼吸道清除功能失效以及身體心像紊亂。護理過程中藉由與個案及家屬建立良好護病關係，針對護理問題提供基本生理需求照護，適時運用藥物及個別性護理措施緩解疼痛，並藉由傷口評估提供受損組織護理，減少傷口滲液異味及提供胸腔物理與藥物治療處理痰液黏稠問題，使個案呼吸道清除功能失效症狀改善，個案術後因傷口滲液異味及臉部外觀改變，經由護理人員與家屬對個案的主動關懷，再以傾聽同理個案面對術後身體心像改變歷程，終讓個案接受身體心像改變事實。

This paper describes a nursing experience of a 55-year-old male patient receiving free flap reconstruction due to oral cancer. The nursing period lasted from Sept. 1 to 18, 2012. Data were collected via Gordon's functional health pattern assessment, and the following health issues were identified: pain, impaired tissue integrity, impaired airway clearance function, and body image disorders. During the nursing process, by establishing a positive rapport with the patient and family, the patient's basic physiological needs were met, pain was relieved through medication and individualized care, tissue care was provided after wound assessment, wound management to avoid wound exudate odor, and thoracic physical and medical therapy to manage viscous sputum and improve impaired airway clearance function. With postoperative facial alteration and odor caused by wound exudate, the nurses engaged in active care for the patient and family by listening to the patient's emotional experience during body image alteration, and finally assisted the patient in accepting the alteration of body image.