照顧一位食道癌病人行空腸造口之護理經驗

A nursing experience of a patient with esophageal cancer after jejunostomy operation

食道癌為死亡率高、存活率低之癌症，食道癌發生有年輕化趨勢，本文是一位48歲罹患食道癌接受空腸造口病人的護理經驗，住院期間出現被動、情緒低落，不參與治療等負向行為，且因照顧者教育程度較低，自認為無法勝任空腸造口灌食及照護，有逃避行為。護理期間為2013年1月17日至2013年2月8日，筆者藉由身體評估、觀察、會談及查閱病歷等方式收集資料，運用Gordon十一項健康功能型態評估，進而確立問題為營養不均衡：少於身體需要/食道癌造成吞嚥困難、術後禁食有關；疼痛/與手術後傷口疼痛有關；身體心像紊亂/與空腸造口導致身體外觀改變有關；焦慮/與不了解空腸造口照護知識有關。照護期間以傾聽、陪伴技巧、回覆示教空腸造口換藥及灌食技巧、分享成功案例等措施，協助個案面對身體心像改變帶來的衝擊以及解決因術後所導致的疼痛，讓個案能面對癌症，提高其生活品質。期盼藉此照護經驗之分享，可供護理人員日後照護此類病人做參考。

Esophageal cancer is one of the cancers with high mortality and low survival rates. There is an increasing incidence in younger population. This article is a case study of a 48-year-old esophageal patient. It gave an overview of the patient’s emotional journey from development of depression hospitalization to refused involvement in individual treatment. In addition, due to poor personnel education, the patient went into denial due to low confidence of management of jejunostomy feeding. During the nursing period between 17 Jan 2013 and 8 Feb 2013, the author used physical examination, observation, interview and reviewing of patient’s chart, and utilized Gordon 11 health functional assessment to aid in data collection. Using the data, the author realized that the main source of problem is malnutrition. A summary of the possible problems and related causes are malnourishment, pain, body image disorder, and anxiety of tube feeding. It was found that during the nursing period, possible resolutions of above issues include listening, companionship, repeated teaching of management, and technique of tube feeding and sharing of successful stories of other victims. These resolutions helped the patient to manage the stress that was brought about from the physical changes and to assist in pain management at the wound area, indirectly improving the management skills of the case and improving the quality of life. We hope that this case study will be able to provide better reference materials for future patient management experiences.