照顧一位喉癌病人行全喉切除手術之護理經驗

Nursing Experience in Caring for a Patient with Laryngeal Cancer Undergoing Total Laryngectomy

本文為描述一位59歲喉癌病人接受全喉切除手術個案，全喉切除術會將氣管直接開口於頸部形成氣管造瘻口，手術後需面臨呼吸方式改變造成痰液無法有效排出及傷口疼痛所造成不適感，更面臨身體外觀改變產生心理衝擊引發探討動機，照護期間為2022年3月29日至4月12日，運用Gordon十一項功能性健康評估，透過實際照護、觀察、會談、病歷查閱等方式收集資料，確立個案有呼吸道清除功能失效、急性疼痛、身體心像紊亂問題。護理過程中藉由主動陪伴並適時關懷，與個案及家屬建立良好護病關係，針對個別需求提供相關護理措施，護理指導以有效咳嗽、胸腔物理治療方式來維持呼吸道的通暢，以藥物及非藥物方式緩解手術後急性疼痛，給予正向支持及運用同理心，協助個案適應手術後外觀、溝通方式的改變。建議全喉切除手術前照會臨床心理師及個案管理師跨團隊照護進行會談，了解個案內心想法，提供無喉疾病團體成功案例分享，出院後能藉由疾病個管師持續追蹤康復狀況，期望此個案照護經驗能提供未來照護喉癌病人行全喉切除手術之護理參考。

This article describes the case of a 59-year-old man with laryngeal cancer who underwent total laryngectomy, which included a tracheostomy, directly access the trachea via an incision in his neck. After the procedure, the patient experienced changes in his breathing pattern, which hindered the effective discharge of sputum and pain cause by untreatable scars tissue. The discomfort caused by pain and the psychological impact of changes in his appearance triggered the motivation to explore. Consequently, a care period was set from March 29 to April 12, 2022. Gordon's 11 functional health assessments were employed, and through actual care and observation, information was collected via interviews and the review of medical records. Following which, it was established that the patient had respiratory tract clearance function failure, acute pain, body and mental disorder. During the nursing process, through active companionship and timely care, we established a good nursing relationship with the patient and his family, provided relevant nursing measures according to the patient's needs, and provided nursing guidance on the maintenance of the respiratory tract's smoothness, on how to produce an effective cough, and provided chest physical therapy. Moreover, post-surgery, we used drugs and non-drugs methods to relieve the acute pain, provided positive support and empathy, and helped the patient adapt to changes in their appearances and communication style. It is recommended that clinical psychologists and the case managers conduct cross-team care talks before total laryngectomy to understand the thoughts of the patient and provide successful case sharing for laryngeal disease-free groups. After discharge from the hospital, the case managers can continued to track the recovery status. It is hoped that this care experience can provide a nursing reference for caring for patients with laryngeal cancer undergoing total laryngectomy.