一位骨肉瘤復發病人面臨安寧抉擇之護理經驗

Experience of Providing Care for a Patient with Recurrent Osteosarcoma Facing Hospice Care Decisions

10.6142/VGHN.202103_38(1).0009

黃莉娟(Li-Chuan Huang)；蘇俞萍(Yu-Ping Su)

骨肉瘤 ； 安寧 ； 復發 ； osteosarcoma ； hospice ； recurrent

榮總護理

38卷1期（2021 / 03 / 01）

78 - 85

繁體中文

本文描述一位20歲女性病人，因骨肉瘤復發合併雙肺轉移及雙側肋膜積水，面臨安寧抉擇之護理經驗。護理期間自2019年12月8日至12月18日。筆者藉由直接照護、身體評估、觀察、會談收集資料，以Gordon十一項功能性健康型態評估，確立病人健康問題有低效性呼吸型態、身體活動功能障礙、預期性哀傷及營養不均衡。護理過程中與病人及家人建立良好治療性關係外，採個別性照護並鼓勵家人齊心參與，藉由協助舒適擺位，教導噘嘴式呼吸技巧及按壓合谷穴等方式改善呼吸喘；設計符合病人的運動計畫，進行下肢全關節運動以維持肌肉力量並增進活動功能；並與安寧共同照護團隊合作，以尊重生命的態度提供安寧照護，讓病人自主選擇末期醫療、善終及心願等規劃，心理照護方面，引導病人及家屬完成四道人生，並提供支持力量，鼓勵彼此表達正負向感受以緩解預期性哀傷，進而提升病人身心靈三平安。

This article discusses the experience of providing care for a 20-year-old female patient who was confronted with hospice care decisions due to a recurrence of osteosarcoma accompanied by bilateral lung metastasis and bilateral pleural effusion. The nursing period was from December 8 to 18, 2019. The patient was evaluated through clinical care, physical assessments, observation, interviews, and Gordon's 11 functional health assessments, and the results revealed the following health problems: inefficient breathing patterns, physical dysfunction, anticipatory grief, and unbalanced nutrition. In addition to the establishment of a good therapeutic relationship with the patient and family members during the nursing process, individual care was provided, and family members were encouraged to participate. To improve the patient's breathing ability, the patient was assisted in comfortable positioning and taught pursed-lip breathing techniques, and the patient's large intestine 4 (＂joining valley＂) acupoint was pressed. Designed in accordance with the patient's exercise plan, total joint exercises of the lower limbs were performed to maintain muscle strength and improve mobility. In addition, cooperation with the hospice care team was coordinated to provide options for peaceful care with a respectful attitude toward life, allowing patients to independently make decisions regarding end-stage medical and hospice care. In terms of psychological care, the treatment guides patients and their families to complete the ＂four paths of life,＂ supports patients and families, and encourages them to express their positive and negative feelings to each other to alleviate grief and improve the patient's mental, physical, and spiritual health.

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