一位初診斷肺癌併腦轉移病人之照護經驗

A Nursing Experience on a Newly Diagnosed Lung Cancer and Brain Metastases Patient

10.6692/KJN.202005/SP_37.0010

陳鈺雯(Yu-Wen Chen)；陳盈蓉(Ein-Zong Chen)；戴嘉真(Chia-Chen Tia)；張滋娉(Tzu-Pin Chang)；李月麗(Yueh-Lih Li)

肺癌 ； 疼痛 ； 焦慮 ； lung cancer ； pain ； anxiety

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

112 - 123

繁體中文

本文為初診斷肺癌轉移腦癌病人之照護經驗。個案因面對突如其來的診斷，個案顯得焦慮、沮喪、沉默不語。筆者在2018年2月17日至3月24日，以觀察、陪伴、會談及身體評估等方式，運用整體性護理評估，確立個案有「急性疼痛」、「口腔黏膜障礙」、「焦慮」等健康問題，提供個別性照護：（一）多模式術後疼痛治療，改善疼痛；（二）口腔護理，改善口腔黏膜炎，促進舒適；（三）運用醫病共享決策工具，幫助個案選擇治療方式，緩解其焦慮與擔心的情緒；（四）藉由家庭成員陪伴及生命回顧方式，鼓勵表達抗癌心路歷程，降低罹病心理之衝擊及害怕。最後個案能以正向的態度接受疾病及治療，適應肺癌腦轉移後身體的改變，進而重回家庭生活。希望藉此經驗分享，提供照護初診斷癌症末期病人之參考。

This case study describes care experience of a patient newly diagnosed with lung cancer and metastatic tumor of the brain. The patient appeared anxious, frustrated, and non-communicative. A holistic nursing assessment, including observation, companionship, individual interview and physical examination was used to collect and analyze data from February 17 to March 24, 2018 by the authors. We comfirmed that the patient actually had some care problems such as acute pain, oral mucosa disorder, anxiety, etc. We also provided individual care, including (1) administering multimodal analgesia to reduce pain; (2) taking care of oral hygiene and improving oral mucositis comfort; (3) helping the patient in choosing the appropriate treatment so that they could relieve anxiety and worry by applying ＂Shared Decision-Making(SDM)＂ ; and (4) encouraging the patient to express experience of anti-cancer in order to reduce the impact and fear of the disease through companionship of family members and life review. Finally, the patient could accept the disease and treatment in a positive attitude, adapting himself to his body changes after lung cancer with a metastatic brain tumor, and then return to family life. This case report provides a valuable nursing care experience as a reference for nursing care in the early stage of lung cancer with a metastatic tumor of the brain.