口腔癌合併食道癌患者手術全期照護

Perioperative Nursing Experience of a Buccal and Esophageal Cancer Patient

本文描述照顧一位罹患口腔癌合併食道癌男性患者，施行口腔及食道腫瘤切除，並行食道胃重建手術之護理經驗，照顧期間為94年10月25日至11月30日；筆者以Gordon十一項功能性健康型態評估為基礎，運用手術全期護理模式，以觀察、傾聽、會談及查閱病歷等方式，對個案進行身體、心理、社會等方面的整體性評估。發現患者健康問題有：焦慮/與即將面臨的手術及未知的結果有關；潛在危險性感染/與手術過程、設備使用有關；潛在危險性損傷/與姿勢擺位、設備使用有關；潛在危險性異物存留/與手術所使用之器械、敷料、尖銳物有關；身體心像紊亂/因頸部手術傷口癒合不良與無法接受身體外觀改變有關。針對其健康問題，筆者藉由適時的關懷及鼓勵，協助患者及家人增加對手術的認知及因應能力，使其焦慮程度減輕；手術中針對臥位運用特殊防護措施，嚴格執行無菌技術；正確計數使用的各項器械、敷料、尖銳物，無傷口感染及異物存留發生；手術後常予探視，藉會談過程提供情緒的宣洩，說明每一次進步的情形，給予正向的鼓勵，協助其接受並正視自己身體外觀的改變。藉由手術全期護理的過程，患者順利安全的完成手術，並於醫療團隊共同努力下逐漸恢復健康。

This article depicts the experience of a through surgical nursing care of a male patient sufferingbuccal and esophageal cancer. Who underwent surgical resection of both buccal tumor andesophageal tumor, and the reconstruction of the digestive tract. The nursing care period was fromOctober 25, 2005 toNovember 30, 2005. The physical, psychological and social aspects of this casewere evaluated and studied by observation, listening, interview and medical chart review. Thispatient was found to have the following problems: (1) anxiety/ related to the coming surgery andunkown surgical result. (2) potential risk of infection and injury/ related to the surgical procedure,positioning, and instrumentation. (3) potential risk of foreign body retention/ related to the surgicalmaterials, instruments and dressings used during the operation. (4) somatopsychic disorder/ relatedto the poor healing of a neck wound and the change of body image. To resolve the above problems,the author provided more information about the operation to the patient and his family, thus releasedtheir tension. During the operation, the dependent and compressed parts of the body were wellprotected. The whole procedure was aseptic and the surgical materials, instruments, and dressingused in the operation were carefully checked, so that neither wound infection nor foreign bodyretention would occur. After the surgery, the aurthor visited and encouraged him frequently, andthrough listening and explaining, the patient finally accepted the changed body image. By a throughperioperative nursing care and a team work, he recovered smoothly from the surgery and got hishealth back.