照顧一位肺癌個案之護理經驗

Nursing Care Plan for a Lung Cancer Patient

10.6880/TJON.202112_21(2).08

張雅晴(Ya-Ching Chang)；蔡惠珠(Hui-Chu Tsai)

肺癌 ； 上腔靜脈症候群 ； 護理經驗 ； lung cancer ； Superior vena cava syndrome ； experience in nursing

腫瘤護理雜誌

21卷2期（2021 / 12 / 01）

93 - 104

繁體中文

本文探討一位57歲肺癌晚期個案之護理經驗，面對醫師宣告疾病對標靶藥物效果不彰之噩耗，加上因呼吸困難、背部疼痛等不適情形，觀察個案常於床上啜泣、愁眉苦臉，引發筆者想深入探討之動機，護理期間自2018年4月11日至5月12日，運用Gordon十一項功能性健康型態評估，經由觀察、實際會談、身體評估及直接照護，收集個案身體、心靈、與社會方面主、客觀資料，確立個案健康問題有氣體交換障礙、疼痛、焦慮三項。照護過程中透過主動關懷、傾聽及陪伴，建立信任的治療性關係，藉由呼吸訓練技巧、合谷穴穴位按摩及藥物使用緩解呼吸喘及疼痛不適，漸進式肌肉放鬆緩解焦慮感受，並鼓勵子女多陪伴，強化案家凝聚力，分享家人共處時光，引導案家與個案表達出對彼此的愛及感謝、肯定努力及付出，透過醫療團隊協助，提供疾病相關資訊，共同討論治療計劃及後續照護，化解個案對疾病進展及無法照料家庭的擔心。建議護理人員多參與安寧療護、癌症相關課程，加強癌症病人身、心、靈層面的照護技能，給予個別性照護，使「非安寧病房」的癌症病人也能獲得更完善的照護，達到善終。期望透過此護理經驗的分享，作為日後照護此類個案之參考，使護理人員獨特角色功能得以發揮。

This article describes the clinical experience of nursing a 57-year-old lung cancer patient with breathing difficulties and back pain. The author has observed multiple times that the patient often sobbed in bed and expressed sadness after the doctor declared the target drugs treatment were ineffective for her. This motivated the author to explore the situation in-depth. From April 11 to May 12, 2018, patient data were collected through observation, discussion with the patient and actual care. Gordon 11 Function Health Patterns was adopted to evaluate patient’s general conditions. Our care plan focused on improving the gas exchange, relieving pain and decreasing anxiety. Through care, listening, and companionship, we aimed to establish a trusting therapeutic relationship. The care process included breathing techniques training, Hegu acupoint massage, analgesics for pain relief, and progressive muscle relaxation techniques. We also helped improve family relationship by encouraging the children to accompany the patient and guiding them all to express their love and gratitude to one another. We provided medical information through the assistance of the medical team and discussed treatment plans and follow-up care with the patient through shared decision making. Nursing staff are advised to take part in the palliative care program and cancer-related courses to strengthen their nursing skills for cancer patients at the physical, mental, and spiritual levels for individualized care. This will ensure that the cancer patients in the general non-hospice care program can also receive adequate palliative care . We hope that by sharing this clinical experience of nursing care, we can establish reference for future care of such patients and demonstrate the unique role of such nursing staff.

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