一位肝癌末期骨轉移病人個案之護理經驗

Caring for a Patient with Terminal Liver Cancer and Bone Metastasis

10.6386/CGN.201809_29(3).0011

方姵文(Pei-Wen Fang)；蔡宜蓁(Yi-Tseng Tsai)

肝癌 ； 疼痛 ； 體液容積過量 ； 無望感 ； liver cancer ； pain ； fluid volume excess ； sense of hopelessness

長庚護理

29卷3期（2018 / 09 / 01）

456 - 466

繁體中文

本文描述一位肝癌末期骨轉移病人面臨身體疼痛不適及自我照顧能力喪失之護理經驗。護理期間自2017年3月16日至4月2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歸納，確立個案有疼痛、體液容積過量及無望感等健康問題。護理過程中提供舒適擺位、穴位指壓及芳香療法，緩解其疼痛不適；教導指壓按摩、控制低鈉限水飲食及嚴密監測輸出入量等，改善體液容積過量問題；運用懷舊療法與家庭支持，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，降低對癌末預後衍生的無望感受。建議醫護同仁重視癌末病人之靈性需求，協助其疾病適應及身心安適，使其能獲得適切性照護，期望經此照護經驗分享，以供臨床實務參考之用。

This paper described the experience of caring for a patient with terminal liver cancer and bone metastases who experienced physical pain and discomfort and loss of self-care ability. The care period was from March 16 to April 2, 2017, and data were collected using interviews, physical assessments, observations, and direct care. A comprehensive evaluation and data integration, analysis, and organization were performed using Gordon's 11 functional health patterns, establishing that the patient had pain, fluid volume excess, and sense of hopelessness. During the caring process, comfortable positioning, acupressure, and aromatherapy were used to relieve pain and discomfort. The patient was instructed in acupressure massage and in controlling a low-sodium diet with fluid restriction, as well as close monitoring of intake and output to mitigate the problem of fluid volume excess. Reminiscence therapy and family support were used to assist the patient with adapting to changes in the disease and strengthening mindfulness, affirming self-worth and reducing the sense of hopelessness caused by terminal cancer. Medical care providers are recommended to pay attention to the spiritual needs of patients with terminal cancer, and to assist them in adapting to the disease as well as attaining physical and mental comfort, thereby ensuring that the patients can receive appropriate care. This care experience is shared as a reference for use in clinical practice.

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