協助一位末期肺癌合併肺癌性淋巴管炎轉移病人善終之護理經驗

End-of-life Palliative Care of a Patient with Terminal Stage Lung Cancer Combined with Pulmonary Lymphangitic Carcinomatosis: A Case Study

10.6880/TJON.201912_19(2).08

顏喜美(Hsi-Mei Yen)；張孔齡(Kong-Ling Chang)；張詩吟(Shih-Yin Chang)

呼吸困難 ； 瞻妄 ； 臨終 ； 預期性悲傷 ； dyspnea ； delirium ； end-of-life ； anticipatory grief

腫瘤護理雜誌

19卷2期（2019 / 12 / 01）

105 - 118

繁體中文

本文敘述協助一位肺癌末期合併肺癌性淋巴管炎轉移病人善終之護理經驗，護理期間為2017年6月30日至7月2日。筆者運用觀察、會談、身體評估及病歷查閱等方式收集資料，並運用安寧療護的全人照顧原則行整體性評估，確立病人有末期呼吸困難、末期譫妄、家屬之預期性哀傷等健康問題。筆者給予病人及家屬全面、持續性且具有個別性之護理措施，護理過程中經由跨領域團隊合作，運用藥物及非藥物方式減輕末期呼吸困難；而瀕死階段之譫妄照護則以維護病人安全為主，主動教導家屬如何陪伴、安撫病人情緒，同時用藥緩解症狀；透過有計畫性的善終關懷措施，鼓勵家屬持續陪伴及表達對於親人即將離去之感受、抒發悲傷情緒，並依病人宗教信仰協助後事準備及安排，並帶領家屬一起參與照護，家人的無助、慌亂感受得以減輕，病人也在家屬陪伴照顧下平安逝世。期許分享此照護經驗，能提供未來照護此類末期病人之參考及運用。

This article describes the author's experiences in providing end-of-life palliative care to a patient with terminal stage lung cancer combined with pulmonary lymphangitic carcinomatosis. The palliative care period was from June 30 to July 2, 2017. The author employed observations, discussions, physical assessments and medical history to collect information on the patient. A holistic approach to palliative care was then used to conduct an overall evaluation which determined the patient had end-stage dyspnea and end-stage delirium, as well as other issues such as the anticipatory grief of family members. The author provided the patient and family members with comprehensive, sustainable and individualized intervention. During this period, an interdisciplinary team worked together to apply pharmacological and non-pharmacological approaches to alleviate the end-stage dyspnea. The care provided for the end-stage delirium was centered on maintaining the safety of the patient and educating family members how to be present for the patient and comfort the patient. Medication was also used to alleviate the symptoms. Family members were encouraged, through systematic end-of-life palliative care measures, to continue to stay by the patient and express their inner feelings about the imminent departure of their loved one and the difficulties of saying goodbye. Assistance with funeral arrangements was also provided in accordance with the patient's faith. The author guided family members to participate in the care, thereby easing their feelings of helplessness and turmoil. The patient peacefully passed away with family members at the bedside. Both the patient and family members were able to achieve peace in both life and death. The author hopes this experience can serve as a reference for the future palliative care of terminal patients.

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