一位肺癌個案初次接受免疫治療之護理經驗

The Nursing Experience of a Lung Cancer Patient Undergoing the First Time Immunotherapy

10.6880/TJON.202306_23(1).06

張維允(Wei-Yun Zhang)；賴青青(Ching-Ching Lai)；謝春金(Chun-Chin Hsieh)

肺癌 ； 免疫治療 ； 焦慮 ； lung cancer ； immunotherapy ； anxiety

腫瘤護理雜誌

23卷1期（2023 / 06 / 01）

69 - 79

繁體中文;英文

本文主描述一位肺癌個案初次接受免疫治療之護理經驗。照護期間自2020年5月29日至6月17日，藉由直接照護、觀察、會談與病歷查閱方式收集資料，並運用Gordon十一項健康功能型態評估，確立個案有氣體交換障礙、皮膚完整性受損及焦慮等健康問題。在護理過程中，透過主動關懷及陪伴，與個案建立良好的護病關係，運用噘嘴式呼吸、小風扇和精油按摩方法減輕其呼吸喘的不適感；教導飲食攝取及正確沐浴方式緩解皮膚搔癢，促進傷口癒合；提供支持性和安全的環境，適時給予情緒支持，引導個案思考，鼓勵積極正向的態度面對問題，降低焦慮。個案初次接受免疫治療，對於治療成效不確定感及副作用而產生焦慮，建議此類病人治療前，可藉由跨團隊照護的介入，協同專科醫師說明免疫治療的藥物療效及副作用，個案管理師予病人說明有關免疫治療之照護方式，讓病人可在第一次面對治療時降低不安感，積極面對治療。同時也希望照護經驗可供護理此類病人的參考。

This article describes the nursing experience of caring for a lung cancer patient who received immunotherapy for the first time. The period of nursing care was from May 29th, 2020 to June 17th, 2020. Data was collected through direct patient care, interviews, and observation of family interaction; The Gordon 11 Function Health Patterns was utilized to evaluate this patient’s health issues, which were identified to be gas exchange disorder, impaired skin integrity, and anxiety. In the nursing care process, through active care and companionship, the author established a good nurse-patient relationship with the patient. The pursed-lip breathing, small fans and essential oil massage methods were employed to alleviate the discomfort of breathing and wheezing; the patient was taught the proper dietary intake and adequate bathing methods to relieve skin itching and promote wound healing; a supportive and safe environment was built for timely emotional support, guidance to help the patient think positive, encouragement for the patient to face treatment, and anxiety reduction. Because it was the first time for the patient to receive immunotherapy, he got anxious about the uncertainty and side effects of the treatment. It is recommended to provide some assistance to reduce the anxiety in patients who undergo the immunotherapy for the first time and help them to face the treatment positively through intervening by the cross-team care, consulting with the specialists to explain the drug efficacy and side effects and explaining the care methods of immunotherapy by the case manager. At the same time, it is hoped that this nursing care experience can be a useful reference for the other nurses caring for the same type of patients in the future.

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