以重症安寧理念照顧一位頸動脈爆裂口腔癌末期個案之加護經驗

Hospice Care for a Terminal Oral Cancer Patient with Carotid Blowout Syndrome in ICU

10.6880/TJON.202012_20(2).08

洪愉婷(Yu-Ting Hong)；何淑芬(Shu-Fen Ho)

頸動脈爆裂症候群 ； 口腔癌 ； 安寧療護 ； 加護病房 ； carotid blowout syndrome ； oral cancer ； palliative care ； intensive care unit

腫瘤護理雜誌

20卷2期（2020 / 12 / 01）

69 - 79

繁體中文

頸動脈爆裂症候群是頭頸部腫瘤病人緊急且嚴重威脅生命的合併症之一，對處於生命飄搖的癌末個案而言，足以擊垮其最後的求生意志，故在臨床照護上應同時導入急重症緊急處置與安寧緩和照護。本文個案原是單純為化學治療而住院，不料突然發生頸動脈爆裂症候群，在執行氣切及血管內處置後又併發右側肢體偏癱而轉入加護病房。筆者在2018年4月21日至5月2日加護病房照護個案期間，應用直接照護、身體評估、病歷查閱等方式收集資料，確立個案主要有「疼痛」、「氣體交換障礙」與「預期性哀傷」主要健康問題，在照護過程中擴展護理角色的照護、諮詢及協調能力，應用舒適照護及疼痛控制技巧等介入措施以緩解癌末疼痛；提供完善的呼吸系統照護，與呼吸治療師討論呼吸器設定模式，維持呼吸道通暢並穩定氧合，避免頸動脈再次出血；主動聯繫醫療團隊與安寧共照師，召開家庭會談，告知不良預後與死亡議題，讓家屬彼此支援共同參與決策困境以降低抉擇衝突，提供符合個案及家屬期望的臨終照護計畫，緩解即將失去至親的哀傷情緒，讓個案最後的生命旅程，在家屬的陪伴中畫下圓滿句點。

This article describes the hospice nursing experience for an oral cancer patient with carotid blowout syndrome transferred to the intensive care unit for the right hemiparesis resulting from the carotid endovascular treatment. The caring period was from April 21 to May 2, 2018 and the Gordon 11 Function Health Patterns was used to conduct the holistic assessment. Data were collected through direct nursing, physical assessment, and medical records. The major health problems identified were pain, dysfunctional gas exchange, and anticipatory grief. We applied pharmaceutical and non-pharmaceutical interventions to relieve pain and maintain airway patency. We also adjusted ventilator modes to stabilize oxygenation and relieve dyspnea. Meetings were held to reach consensus between family and the medical team, establish nursing goals, and to work with the hospice care team to complete the final life's journey of the patient in the company of the family members. This was an experience of integrating critical care with palliative care resources to improve the quality of life for the critically ill patients and to implement the hospice concepts of the whole person, whole family, whole course, and whole team. We hope this can be used as a reference for future care of such patients.

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