照護一位口腔癌病人手術後期間之護理經驗

Nursing Care Experience for a Patient with Oral Cavity Cancer Postoperative

本文運用羅氏適應模式，經由直接照護、會談和觀察，確立個案有口腔黏膜改變、疼痛、身體心像紊亂健康問題。個案因手術治療，造成口腔黏膜破壞，護理過程中生理方面，運用口腔黏膜照護指引，規則與個案共同執行口腔清潔護理，增進口腔黏膜傷口癒合、降低異味產生；以視覺類比量表為疼痛評估工具，並依據WHO的癌症疼痛緩解三階梯原則，與醫療團隊討論調整止痛藥物、利用轉移注意力和按摩技巧，有效緩解疼痛不適；心理方面，引導家人陪伴，引發個案與病友分享口腔癌腫瘤切除和皮瓣移植重建術癒後調適，護理人員主動關懷，幫助個案調適顏面改變的心理衝擊，並適應術後身體變化歷程，進而達到生、心理最佳適應狀態，回歸原本的社會生活。藉本文護理經驗分享，提升日後護理同仁照護此類個案之參考。

The Roy’s adaptation model was used to assess nursing problem through direct care, interview, and observation. The nursing problems being identified included oral mucosa change, pain, and body image disturbance. During the period of care, for oral mucosa change caused by surgery, by applying oral mucosal care guideline, we helped perform oral cleaning and care regularly to improve oral mucosal healing and decrease odour. We used the Visual Analogue Scale assess the pain. By following the WHO three steps analgesic ladder, we discussed with the medical team to modify analgesics and used attention diversion and massage to effectively alleviate pain and discomfort. In psychological aspect, we requested family members to accompany the patient, encouraged the patient sharing experiences of tumor resection and flap reconstruction with others patients, and provided active caring to help the patient adjust for psychological impact and physical change to improve physical and psychological well-being so that the patient can return to social life normally. This experience provided nurses with a reference for caring similar patients in the future.