一位肺癌骨轉移復發病人之照護經驗

Nursing Experience of a lung Cancer Patient who Relapsed with bone Metastases

鄭念慈(Nien-Tzu Cheng) ； 楊佩瑄(Pei-Hsuan Yang)

《澄清醫護管理雜誌》 14卷3期 (2018/07) Pp. 59-68

摘要

本文探討一位肺癌病人，接受轉移性骨腫瘤手術、化學藥物治療與放射線治療後，因腫瘤復發壓迫脊椎導致雙下肢癱瘓無法行走而面臨癌症疼痛、身體活動受限及面對疾病惡化的預期性哀傷之護理問題。筆者於2015年9月11日至2015年9月22日門診跟診及注射室照護期間，以Gordon十一項功能性健康評估工具，藉訪談、觀察照護等方式收集主、客觀資料，確定個案健康問題為疼痛、身體活動功能障礙、預期性哀傷。筆者教導個案配合醫師處方正確使用止痛藥物，並運用轉移注意力、肌肉放鬆按摩技巧來降低骨轉移所造成的疼痛不適；協助個案照會復健科，配合復健師運動處方進行物理及職能復健，鼓勵個案執行主動與被動關節運動，增進肢體活動力；同時運用家人支持系統及宗教信仰力量，傾聽並接納個案情緒表達，鼓勵其堅強面對疾病復發之挑戰，以正向態度面對悲傷過程提升生命品質。作者期望藉此個案報告，提供臨床護理人員未來照護此類病人之照護經驗參考。

關鍵字

肺癌 ； 骨轉移 ； 疼痛 ； 身體活動功能障礙 ； 預期性哀傷

並列摘要

This article describes the nursing experience of a lung cancer patient, who underwent surgery, chemotherapy, and radiotherapy for bone metastases and experienced tumor recurrence with spinal compression. This caused paralysis of the lower limbs and resulted in pain, the inability to walk, limited physical mobility, and anticipatory grief in the face of disease exacerbation. The author collected subjective and objective data through interviews and observation using Gordon's functional health assessment tool in the outpatient clinic and injection room from September 11-22, 2015. Three major health problems were identified: pain, physical activity dysfunction, and anticipatory grief. The author taught the patient how to properly use analgesic medications that had been prescribed by the physician and techniques such as attention diversion and muscle relaxation massage to reduce pain and discomfort caused by bone metastases. The author also assisted the patient in receiving rehabilitation, including physical therapy and occupational therapy, to promote physical activity. The patient was encouraged to carry out active and passive joint exercises to improve physical activity. At the same time, family support systems and religious beliefs were used to listen to the emotions of the patient and encourage the patient to be strong in the face of the challenge caused by disease recurrence, so that the patient could face the grieving process with a positive attitude and improve his/her quality of life. The author hopes that this case report can provide nursing experience as a reference for the future care of this type of patients by clinical nurses.

並列關鍵字

Lung cancer ； Bone metastases ； Pain ； Physical activity dysfunction ； Anticipatory grief