肺癌病人首次化學治療不慎藥物外滲之照護經驗

Care Experience of a Lung Cancer Patient Developing Extravasation during First Chemotherapy

10.3966/102673012017122804008

黃婕榕(Jie-Rong Huang)；黃姿菁(Zih-Jing Huang)；杜慧茹(Huei-Ru Du)；陳宜欣(Yi-Shin Chen)；蔡宜蓁(Yi-Tseng Tsai)

肺癌 ； 化學治療 ； 外滲 ； lung cancer ； chemotherapy ； extravasation

長庚護理

28卷4期（2017 / 12 / 01）

665 - 676

繁體中文

本文探討一位肺癌首次接受化學治療的老年女性，化療期間不慎拉扯管路導致藥物外滲不良反應，併發身心不適及難以預測病情變化衍生無望感之照護經驗。筆者於2015年9月2日至11月19日，利用觀察、會談及身體評估等技巧收集資料，運用Gordon十一項功能性健康型態行整體性系統評估，發現病人出現焦慮、皮膚完整性受損及無望感等問題。護理期間運用關懷陪伴建立信任護病關係，使其瞭解診療計畫及提供化學藥物相關資訊，增加對疾病控制感，以減輕其焦慮不安；針對皮膚外滲損傷成立醫療關懷小組，提供傷口照護及後續追蹤，以降低外滲傷害；協助病人適應疾病變化及增強正向信念，肯定自我存在價值，降低罹癌衍生的無力感。建議醫護同仁加強病人及照顧者肺癌化學治療居家照護技能，使其身、心皆獲得適切性照護及降低肺炎感染風險，期望經此照護經驗分享，以供臨床實務參考之用。建議醫護同仁重視癌症病人發生化療外滲之緊急應變措施及返家照護技能，使其身、心獲得適切性照護及降低外滲傷口感染風險，期望經此照護經驗分享，以供臨床實務參考之用。

This study reported the care experience of an older woman with lung cancer undergoing chemotherapy for the first time, during which an intravenous line was accidentally pulled, causing extravasation and leading to adverse reactions. The condition was complicated by psychophysical discomfort, which along with unpredictable changes caused a sense of hopelessness in the patient. Data were collected from September 2 to November 19, 2015 through observation, interviews and a physical assessment. Gordon's 11 functional health patterns were used to perform an overall health assessment; anxiety, impaired skin integrity, and feelings of hopelessness were observed in the patient. Care and companionship were employed to establish trust in the nurse-patient relationship. The nursing team explained the treatment plan and provided chemotherapy drug-related information to the patient to enhance her sense of control over the disease and to reduce her anxiety. A health care team was formed to treat the extravasation wound and provide follow up to reduce skin damage. The team helped the patient adapt to changes in the disease, boost her optimism and confidence in her self-worth, and reduce her sense of powerlessness arising from the cancer. The author recommends that health care professionals enhance the lung cancer chemotherapy home care skills of the patient and her caregiver so that the patient can receive appropriate physical and mental care and to reduce the risk of pneumonia. The author also recommends that health care professionals emphasize emergency measures for extravasation in cancer patients in addition to home care skill, so that patients can receive appropriate physical and mental care and so that the risk of infection of the extravasated area can be reduced. This experience may serve as a reference for clinical practice.

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