照顧一位口腔癌接受口顎皮瓣重建手術之加護經驗

The Nursing Experience of an Oral Cancer Patient Receiving Mouth-Jaw Flap Reconstruction in an Intensive Care Unit

口腔癌病患接受口顎皮瓣重建手術後，需面臨生心理改變之多重衝擊，急性期時，若未予以提供密集性照護，恐影響皮瓣存活，進而造成病患及家屬額外負擔，顯示加護階段照護之重要。本文陳述一位49歲男性，罹患口腔癌接受口顎皮瓣重建手術住加護病房的護理經驗。筆者於2011年5月19日至5月25日，運用觀察、身體評估及會談，收集資料及歸納分析進行生理、心理、社會及靈性之整體評估，確立主要健康問題有：組織灌流改變、疼痛、焦慮及身體心像紊亂，護理期間針對病患之個別性擬訂護理計畫，術後密切監測口內皮瓣的血流灌注情形，提早發現皮瓣循環異常，減少移植皮瓣失敗；減輕氣切套管留置和術後頸部傷口疼痛；提供充份衛教、詳盡的解釋，減少其焦慮；採持續性的關懷、傾聽並以同理心的態度及給予正向鼓勵引導表達內心感受，以面對身體外觀的改變。希望能藉此護理過程之經驗分享，期能提供護理同仁對日後照顧此類個案有更深一層的認識，能給予更適切的護理。

Oral cancer patients who received mouth-jaw flap reconstruction are facing tremendous impact physically and mentally. Close monitor is essential during the acute stage to ensure flap survival. Poor flap survival results in additional burden to the patients and their caregivers, highlighting the importance of nursing care in the intensive care unit. .This report described the nursing experience for a 49 year-old-male with oral cancer who received mouth jaw flap reconstruction surgery and stayed in the intensive care unit. Nursing care was provided from May 19 to 25, 2011. Data was collected by observation, physical assessment, and interviewing. Mental, social, and spiritual domains were used to identify patient’s problems, which included tissue perfusion altered, pain, anxiety, and body image disturbed. The authors provided individualized nursing intervention to promote flap perfusion and alleviate wound pain. Adequate information was provided to relieve anxiety. The patient was encouraged to express his feeling and to adapt changes of his physical appearance. This report provides nurses with a reference for caring similar patients in the future.