一位食道癌行食道重建手術病人之照護經驗

An Nursing Experience of Caring a Patient of Esophageal Cancer with Esophageal Reconstruction

本文敘述一位罹患食道癌入院執行食道癌重建手術中年男性，護理期間自2019年11月17日至12月13日，經由會談、身體評估、觀察及直接照護等方式收集資料，運用Gordon十一項健康功能型態評估進行整體性評估及資料整合分析，確立個案有吞嚥障礙、呼吸道清除功能失效及無力感等健康問題。護理過程依個別性擬定營養計畫，評估食物濃度及質地及調整進食姿勢降低嗆咳風險，增強口腔肌肉運動降低吞嚥困難障礙；醫療提供支氣管擴張藥物及蒸氣吸入促進黏膜濕潤，教導有效深呼吸咳嗽及叩擊以利痰液排出，以維持呼吸道通暢；醫護團隊建立信任性護病關係，運用同理心主動傾聽陪伴，鼓勵其抒發擔憂不安之事及宣洩情緒，適時予以正向支持，協助其適應疾病變化，以降低其無力感受。期望經此護理經驗分享，以供臨床實務參考之用。

This article presents the case of a middle-aged male patient who underwent esophageal reconstruction surgery following a diagnosis of esophageal cancer. Nursing care was provided from November 17, 2019, to December 13, 2019. Data were collected through patient interviews, physical examinations, observations, and direct care. Comprehensive assessment using Gordon’s 11 Functional Health Patterns identified key nursing problems, including dysphagia, ineffective airway clearance, and powerlessness. During the nursing process, an individualized nutritional care plan was developed. Food concentration and texture were adjusted, and proper eating posture was emphasized to reduce the risk of choking. Physiotherapeutic exercises were implemented to strengthen oral muscle movement and alleviate dysphagia symptoms. Medical management included the use of bronchodilators and steam inhalation to prevent mucosal dryness. The patient was also taught deep-breathing, effective coughing, and chest-clapping techniques to promote sputum clearance and maintain airway patency. A therapeutic and trusting nurse–patient relationship was established through active listening, empathy, and consistent companionship. The nursing team encouraged the patient to express anxiety and discomfort while providing timely emotional support to enhance adaptation to illness and reduce feelings of powerlessness. This case demonstrates the importance of holistic, patient-centered nursing interventions in promoting recovery and psychological adaptation among patients undergoing esophageal reconstruction. The experience offers valuable insights and practical guidance for clinical nursing practice.