一位急性頸動脈爆裂頭頸癌個案之護理經驗

Nursing Experience of a Patient With Acute Carotid Blowout Syndrome in Head and Neck Cancer

10.6142/VGHN.201812_35(4).0010

邱文姿(Wen-Tzu Chiu)；李芸湘(Yun-Hsiang Lee)

頭頸癌 ； 頸動脈爆裂症候群 ； 護理經驗 ； head and neck cancer ； acute carotid blowout syndrome ； nursing care

榮總護理

35卷4期（2018 / 12 / 01）

419 - 426

繁體中文

頭頸癌個案發生頸動脈爆裂時，是臨床上緊急且危急生命的腫瘤急症，常需合併安寧緩和照護，對醫護人員造成沉重照護壓力，對個案與家屬也是面臨前所未有的生命嚴重威脅，發生時也是非常的錯愕、徬徨與焦慮的經驗。有鑑於本案例在2016年4月19日至5月2日住院過程中，突然發生急性頸動脈爆裂症候群，透過觀察、身體評估、訪談記錄、查閱病歷等方式進行資料收集，發現個案有「腦組織灌流改變」、「抉擇衝突」與「死亡焦慮」等健康問題。護理重點以專科護理師角色主動連結醫療團隊進行緊急處置及照護措施上提供疾病緊急照護措施，以緩解個案腦組織灌流改變狀況；同時，告知疾病不良預後、提供正確照護過程與相關知識、提供安寧療護相關資訊、協助家庭成員彼此支援互動，進而共同參與討論治療計劃，面對決策選擇困境，以減少決策衝突發生，使其能有最適切符合個案期望的決定與有尊嚴的生命旅程照護計畫，以協助面對死亡焦慮，促進個案對生命價值之意義與滿足，陪伴個案度過末期恐懼並做好臨終準備。

This article describes the nursing experience of a patient with head and neck cancer who had sudden acute carotid blowout syndrome from April 19 to May 2, 2016. Acute carotid blowout syndrome occurs because of massive bleeding, which clinically requires emergency care and is a severe threat to the patient's life. Carotid blowout syndrome can cause emotional shock, anxiety, and heavy care burden to medical staff and families. The data collected through clinical assessment, behavior, and communication records, the three critical nursing sources of information, included brain perfusion changes, conflict in the decision-making process, and anxieties concerning death. This article describes the process of linking a medical team to emergency treatment and assisting family members in interacting and supporting each other with the help of a nurse practitioner. The decision-making process entails discussions with the family about unfavorable disease prognoses, providing accurate care with the relevant knowledge and nursing procedures, and handling ethical concerns and hospice care concerns. The results can help encourage the family to participate in the discussion, planning, and further treatment, which can be the most appropriate course for an individual.

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