照護一位初次診斷口腔癌病人術後照護經驗

Experience Caring for a Patient with Recently Diagnosed Oral Cancer after Surgery

本文主要探討一位56歲男性個案初次診斷口腔癌行皮瓣重建手術之全期護理照護經驗，手術後因身體外觀改變造成身、心理上影響。護理期間自2022年5月12日至5月28日，筆者藉由觀察、溝通、身體評估、會談等方式蒐集個案資料，以Gordon十一項功能性健康型態架構為評估工具，確定個案有疼痛、呼吸道清除功能失效及身體心像改變之護理問題。護理過程提供藥物及放鬆技巧來緩解疼痛；主動給予陪伴及關懷，建立彼此良好的護病關係，提供個案個別性的護理措施；使用噴霧治療及胸腔物理治療，協助痰液排出以減少不適感；協助個案調適身心狀態面對身體外觀改變，與疾病所帶來的壓力，重建個案自我心像之完整。當病人身體心像改變造成壓力無法有效處理時，易產生無助感及焦慮，導致建立護病關係上的困難，應特別注意個案心理層面產生的問題，協助他們面對外觀改變上的正向態度，也建議可製作手術全期影片，讓病人及家屬可以清楚了解到手術治療全期可能面臨的相關問題，減少其徬徨、忐忑情緒，使其能順利出院，針對重建手術後病人建檔追蹤，了解居家照護狀況，以提升或改善居家照護品質。希望藉此照護經驗，提供醫護人員在照護口腔癌重建病人上之參考，以提升照護品質。

This article discusses the nursing experience of a 56-year-old male patient who underwent an oral cancer diagnosis and skin flap reconstruction surgery. After the surgery, the patient experienced physical and psychological effects due to changes in his appearance. During the nursing period from May 12, 2022 to May 28, 2022, we collected case data through observation, communication, physical assessment, and interviews, using Gordon's Eleven Functional Health Patterns as an assessment tool. Nursing problems identified in the case included pain, ineffective airway clearance, and changes in body image. Medication and relaxation techniques were provided to alleviate pain. Active companionship and care were given to establish a good nurse- patient relationship, and individualized nursing measures were provided. Spray therapy and chest physiotherapy were used to help clear secretions and reduce discomfort. The physical and mental state of the patient was attended to due to changes in appearance and stress brought about by the illness. Patients who develop physical and psychological changes that cause stress may develop feelings of helplessness and anxiety, making it difficult to establish a caregiving relationship. Particular attention should be paid to the psychological issues that arise in individual cases, and efforts should be made to assist these patients in adopting a positive attitude toward changes in their appearance. We recommend creating a video of the entire surgical period so that patients and their families clearly understand the relevant issues facing them during surgery, which will reduce confusion and anxiety and help them discharge smoothly. Follow-up records should be kept for patients who have undergone reconstructive surgery to understand and improve the quality of their home care. We hope to provide a reference for healthcare professionals in caring for patients undergoing reconstruction for oral cancer to improve the quality of care.