照護一位齒齦癌病人接受游離肌肉皮瓣重建手術之護理經驗

Nursing Experience in Caring for a Patient with Gum Cancer Underwent Muscle Flap Reconstruction

罹患齒齦癌病人主要治療以廣泛性切除病灶區，再以肌肉皮瓣重建手術覆蓋，然而重建後因外觀改變易造成病人身心理衝擊。個案為齒齦癌病人，照護期間為2018年7月2日至7月7日，運用觀察、會談、病歷查閱與直接照護方式收集資料，評估病人身、心、社會及靈性層面，歸納分析病人有組織完整性受損、口腔黏膜改變及身體心像紊亂之健康問題。照護期間密切監測皮辦血循，提供傷口照護衛教單張指導病人及家屬傷口照護方式，以維護皮瓣血循及降低傷口感染風險；教導正確執行口腔清潔，預防痰液鬱積，進而改善口腔黏膜潰瘍情形；透過正向心理支持與鼓勵，引導其表達外觀、結構及功能改變之內心感受，減少術後造成身體外觀改變的不安及焦慮。未來建議醫療團隊於住院期間即能納入復健師，教導吞嚥訓練，以為移除鼻胃管做準備，增加吞嚥能力。筆者期望藉由此護理經驗過程分享，提升齒齦癌病人接受游離肌肉皮瓣重建手術術後護理照護品質。

This report describes the nursing experience of caring a patient with gum cancer who undergo extensive resection and subsequent muscle flap reconstruction surgery to cover the defect area. However, such procedures can lead to physical and psychological challenges for patients. The objective of this case study is to demonstrate how nursing interventions can help patients navigate through this challenging journey towards independent functioning. The nursing care period extended from July 2nd to July 7th, 2018. Data collection involved various methods, including observations, interviews, medical records, and direct care, using a holistic approach to assess and formulate nursing problems. Impaired tissue integrity, oral mucosal changes, and body image disturbance were identified as the three main nursing problems. Throughout the care period, careful monitoring of the skin's blood circulation was prioritized, and informative leaflets on wound care were provided to guide patients and their families in maintaining proper blood circulation of the flap and reducing the risk of wound infection. Patients were also educated on correct oral cleansing techniques to prevent sputum accumulation and improve oral mucosal ulcers. Additionally, positive psychological support and encouragement were offered to guide patients in expressing their emotions and coping with changes in appearance, structure, and function following surgery. Moving forward, it is recommended that the medical team include a rehabilitation teacher during the hospitalization period to provide swallowing training in preparation for the removal of the nasogastric tube and to enhance swallowing ability. By sharing this nursing experience, we aim to improve the quality of care for patients with gum cancer undergoing muscle flap reconstruction surgery.