照護一位口腔癌術後管路阻塞個案之經驗

The Experience Providing Nursing Care to a Postoperative Oral Cancer Patient Experiencing Obstruction of a Tracheostomy Tube

本文主旨為探討一位48歲男性口腔癌術後氣切管路阻塞之照護經驗，護理期間自2018年3月3日至3月22日，以觀察、筆談及Gordon十一項功能性健康評估架構，確立健康問題有呼吸道清除功能失效、急性疼痛、睡眠型態紊亂及恐懼。經由口腔外科、胸腔外科及整形外科醫師、呼吸治療師、個案及主要照顧者等跨領域團隊人員擬定呼吸訓練計畫，緩解急性疼痛及呼吸道阻塞的恐懼，成功移除個案氣切管路。臨床建議照護困難複雜性疾病的個案可經由團隊共同建立相關照護標準，減少醫療分歧，期許此經驗提供日後口腔癌氣切管路留置個案照護參考。

This report describes the experience of nursing care to a postoperative oral cancer patient experiencing the obstruction of a tracheostomy tube. The information was collected from March 3rd until March 22th, 2018 by observation, recording, and Gordon's 11 functional health patterns. Health problems of ineffective airway clearance, acute pain, disturbed sleep pattern, and fear were identified. The patient suffered from the fear of the tracheostomy tube obstruction and the postoperative pain. Active care, analgesic drugs, and education of pain coping skills were provided. Respiratory training plan aimed to relieve acute pain and the fear of airway obstruction was made with multidisciplinary cooperation, including the members of oral surgeons, chest surgeons, plastic surgeons, respiratory therapists, nurses, caregiver, and patient himself. Eventually, the tracheostomy tube was removed successfully. We suggested that caring plan for complex, difficult caring patients can be discussed by multidisciplinary cooperation to reduce clinical disagreement. The experience was expected to help nurses caring similar cases.