一位末期腎細胞癌服用Sunitinib導致左心衰竭個案之護理經驗

Nursing Care for an End-stage Renal Cell Carcinoma Patient with Left-sided Heart Failure Induced by Sunitinib

10.3966/168395442016061601008

簡婉如(Wan-Ju Chien)；洪嘉蕙(Chia-Hui Hung)；周繡玲(Hsiu-Ling Chou)

腎細胞癌 ； 標靶治療 ； 左心衰竭 ； renal cell carcinoma ； targeted therapy ； left-sided congestive heart failure

腫瘤護理雜誌

16卷1期（2016 / 06 / 01）

73 - 84

繁體中文

標靶治療是癌症治療新趨勢，目的在於減緩化學治療藥物的傷害，但仍有不可預期之副作用。本篇個案報告主要是描述一位末期腎細胞癌患者服用標靶治療藥物Sunitinib (Sutent®)導致左心臟衰竭副作用之護理經驗，護理期間為2012/8/13至2012/8/30。筆者運用Gordon十一項功能性健康型態評估收集資料，並透過直接照護、身體評估、觀察、會談等方式，發現個案有體液容積過量、低效性呼吸型態及預期性哀傷等健康問題。藉由監測體液輸入/輸出量及改變週邊組織水腫，降低心臟負荷；密切觀察生命徵象及氧合狀況，給予適合之呼吸照護；並且主動關懷，鼓勵個案及家屬表達情感，緩解哀傷情緒，藉由生命回顧及引導回想以往美好事物，肯定其生命意義，提升個案對疾病及治療的正向認知。因標靶藥物而導致心臟衰竭副作用之個案，臨床上較為少見，故筆者期能藉此護理經驗，提供護理人員日後照護類似個案之參考，以提供更完整的照護品質。

There is very few clinical report of the left-sided heart failure side effect induced by targeted therapy of Sunitinib. This article describes the experience of nursing an end-stage renal cell carcinoma patient with Sunitinib-induced left-sided heart failure. The nursing care period was from August 13 to 30, 2012. Data were collected through interviews, observation, and the Gordon 11 Health Functional Patterns assessment. The patient's health problems were identified as excess fluid volume, ineffective breathing pattern, and anticipatory grieving. We followed the appropriate nursing care protocol and kept a logged record of fluid input/output to monitor the peripheral tissue edema and the cardiac load to measure his vital signs and oxygenation for close respiratory care. We took a holistic approach which enabled us to ameliorate his discomfort and help him focus on positive thinking; we also encouraged both patient and family to express their emotions and to make informed decisions about the medical interventions. We hope this nursing experience can provide some guidelines for clinical nurses during their care of patients in similar conditions.

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