一位肝癌病患初次行肝動脈化學藥物栓塞治療之護理經驗

The Nursing Experience of a Hepatocellular Carcinoma Patient with The First Transcatheter Arterial Chemoembolization

10.6880/TJON.201810/SP_18.05

郭志強(Chih-Chiang Kuo)；陳秋曲(Chiu-Chu Chen)

肝癌 ； 肝動脈化學藥物栓塞治療 ； 護理經驗 ； hepatocellular carcinoma ； transcatheter arterial chemoembolization ； nursing experience

腫瘤護理雜誌

18卷增訂刊（2018 / 10 / 01）

53 - 63

繁體中文

本文描述一位肝癌病患初次行肝動脈化學藥物栓塞治療之護理經驗。照護期間為2015/6/22至2015/7/7，筆者運用Gordon十一項健康功能型態評估，經由觀察、會談、傾聽等方法進行資料收集，確立個案有體溫過高、急性疼痛與不確定感等護理問題。在提供適切的護理措施及個別指導後，讓個案了解經肝動脈化學藥物栓塞治療造成發燒的原因；對於治療後的疼痛問題，與個案訂定降低疼痛治療計畫，將疼痛分數目標訂定在降低到2分以下，並持續追蹤個案疼痛改善情形；在個案初次罹患肝癌對於疾病的不了解與不確定感時，與其會談以了解個案對疾病的認知程度後，與醫師共同進行討論，澄清個案疑慮並給予適當的衛教指導，提升對於治療的認同感與信心，故在照護此類病患時，能主動發現不確定感，才能儘早讓病患勇於面對自己的疾病，更積極的配合治療，使肝癌病患在治療過程中能得到更完善的照護。

This article describes the nursing experience of a Hepatocellular Carcinoma patient with his first transcatheter arterial chemoembolization (TACE). The duration of nursing care was from June 22th to July 7th, 2015. The author used observations, interviews and Gordon's functional health pattern model to gather and analyze data. The results revealed three major health issues: Hyperthermia, acute pain, and uncertainty. We provided appropriate care measures and individual guidance to help the patient understand the association between the transcatheter arterial chemoembolization and fever. We also addressed the post-treatment pain by setting a treatment program with the patient to reduce the pain; the goal of which is to decrease pain level to 2 score or under and keep continuous monitoring. As for the uncertainty experenced by the patient, we took the initiative of involving primary physicians to explain all disease related progression and prognosis to deliver clarity and hope in patient to cope with the disease more effectively. Upon notice of uncertainty in patients, the sooner we educate the patient on related healthcare and disease information, the better we can deliver effective quality of nursing care.

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