照護一位罹患尤文氏肉瘤病童接受質子治療之護理經驗

Post Proton Therapy Nursing Care for a Child Patient with Ewing's Sarcoma

10.6880/TJON.202212_22(2).10

留英珊(Ying-Shan Liu)

尤文氏肉瘤 ； 質子治療 ； 學齡前期兒童 ； Ewing's sarcoma ； proton therapy ； preschool children

腫瘤護理雜誌

22卷2期（2022 / 12 / 01）

129 - 140

英文

尤文氏肉瘤（Ewing's sarcoma）是一種高度惡性原發性骨腫瘤，需合併化學治療及放射線治療，放射線照射95%會產生放射線皮膚炎，嚴重會造成感染死亡或迫使治療中斷，導致癌症復發。本文主要探討一位罹患尤文氏肉瘤病童接受質子治療，因放射線照射引發皮膚破損及疼痛，出現哭鬧、抗拒不配合，情緒起伏大，造成生理不適及心理衝擊之護理經驗。筆者照護期間自2019年4月7日至2019年5月6日，運用Gordon十一項功能性健康型態評估表為工具，藉由直接照護、觀察、會談、傾聽等收集資料，確立有：疼痛、皮膚完整受損及恐懼三項健康問題。照護過程筆者與醫療團隊討論傷口照護方式，教導案母減少對皮膚的刺激、促進傷口的癒合，提升傷口照護能力；並藉由個案喜愛卡通轉移對疼痛的注意力，適時予止痛藥物使用，改善疼痛問題，促進舒適感；住院中個案對打針、質子治療等侵入性治療充滿恐懼害怕，經導入治療性遊戲，利用玩偶角色扮演，讓病童瞭解治療目的，提高遵從度，並由心理師引導表達內心負面的情緒，減輕住院中的壓力。期望藉由此照護經驗分享，提供日後病童接受質子治療前，能及早做好皮膚的預防照護或放射皮膚炎處置，提升優質照護品質。

Ewing's sarcoma (Ewing's sarcoma) is a highly malignant primary bone tumor that requires a combination of chemotherapy and radiation therapy. Radiation dermatitis occurs in 95% of the patients, which may cause infection, death, forced treatment interruption, and cancer recurrence. This article mainly discusses the nursing care experience for a Ewing's Sarcoma child patient receiving proton therapy. Radiation exposure caused this patient to suffer from skin damage and pain, emotional reaction such as crying, resistance, and incompliance, unstable mood swings, physical discomfort and psychological shocks. During the nursing care period (April 7, 2019 to May 6, 2019), by using the Gordon's 11 Functional Health Assessment Form as a tool, the author collected data through direct bedside care, observation, interview, and listening, etc. It was determined the health concerns were: pain, skin damage, and fear. During the nursing process, the author discussed wound care methods with the medical team and taught the patient's mother how to reduce skin irritation, promote wound healing and improve homecare quality. The author used the patient's favorite cartoon to divert his attention from pain, and painkillers to improve the pain problem and provide comfort; during hospitalization, the patient was full of fear towards the invasive treatments such as injection and proton therapy. With the help of therapeutic games, role-playing dolls, the author helped the child patient to understand the purpose of treatment, improve compliance, and express inner negative emotions under the guidance of psychologists, which also reduced the pressure of hospitalization. It is hoped that this article could help prevent skin damage before the proton therapy and deliver better treatment and care for the radiation dermatitis in the future, and to improve the overall quality of patient care in similar cases.

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