肺癌病人初次接受標靶治療造成皮膚毒性的急診照護經驗

Nursing Care Experiences of Lung Cancer Patient with Dermatologic Toxicities to First-Time Targeted Therapy at Emergency Department

10.6740/NTUHJN.201801_14(1).0007

古乃文(Nai-Wen Ku)；楊蓓菁(Bey-Jing Yang)

肺癌 ； 標靶藥物 ； 皮膚毒性 ； Lung cancer ； Targeted cancer therapy ； Dermatologic toxicity

臺大護理雜誌

14卷1期（2018 / 01 / 01）

55 - 66

繁體中文

本文探討肺癌個案於經歷癌症復發的診斷後，初次接受標靶治療造成皮膚毒性至急診就醫，個案除了需因應服用標靶藥物後相關的副作用，還需面對身體心像的改變而影響生活和社交活動；且擔心癌症病況惡化，身心的困擾需由護理照護的介入。照護期間從2016年8月2日到6日，以羅氏適應模式進行整體性護理評估，確認個案有三項主要的健康問題：營養需求少於身體所需、皮膚完整性受損及身體心像紊亂。透過跨領域合作、正向激勵、促進口腔黏膜潰瘍改善和皮膚毒性相關衛教措施的協助，使個案能正向調適癌症復發的衝擊，以及口服標靶藥物引起皮膚毒性所造成的身體心像改變，進而能重建自我認同找到生命的意義與價值。

This article described the lung cancer patient seeking emergency service for dermatologic toxicity to first-time targeted therapy, after a diagnosis of lung cancer recurrence. This patient not only needed to learn how to manage dermatologic toxicity from the targeted therapy but he was also confronted with the impacts of body image on his life and social activity. Moreover, he worried about the progression of cancer. His physical and psychological distress required nursing interventions. The period of nursing care was from 2 to 6 August 2013. After completing nursing assessments using Roy's adaptation model, the major health problems of nutrition imbalanced less than body requirements, impaired skin integrity, and disturbed body image were identified. With multidisciplinary cooperation, providing patient empowerment, nursing education about the care of oral mucositis and dermatologic toxicity, the patient was able to confidently cope with the impacts of cancer recurrence and change of body image due to the targeted therapy. Finally, the patient could establish the positive self-concept and purpose in life.