- 期刊
一位卵巢癌合併副腫瘤症候群多發性肌炎之護理經驗
Nursing Experience from Caring for a Patient with Ovarian Cancer Complicated by Paraneoplastic Syndrome and Polymyositis
摘要
副腫瘤症候群是癌症罕見的併發症，好發率1%-8%，一旦因癌症誘發副腫瘤症候群，死亡率增加47.3%。本文描述一位72歲卵巢癌合併副腫瘤症候群多發性肌炎個案，面對疾病造成自我照顧能力喪失，對預後感到無望，出現許多的負面情緒，故引起筆者照護的動機。護理期間為2022年4月19日至5月7日，藉由會談、觀察、直接照護及配合Gordon十一項功能性健康型態評估等方式收集資料，確立個案主要有吞嚥困難、身體活動功能障礙、無望感等健康問題。照護過程中首先建立良好的護病關係，透過跨團隊合作共同討論、擬定個別性復健計劃，使個案恢復吞嚥功能，成功移除鼻胃管，並提升自我照顧能力、增強個案對抗疾病的控制感，增進希望，進而提升生活品質。出院後筆者利用電訪持續追蹤個案居家生活2個月，並轉介本院癌症個管師作為收案個案，以達連續、整體性之全人照護。建議可拍攝吞嚥訓練多媒體教材，盡早給予衛教指導並配合影音回覆示教，爭取充裕時間做出院前準備，增進返家後的生活品質。期望藉此護理經驗分享，作為日後照護類似個案之參考。
並列摘要
Paraneoplastic syndrome is a rare complication of cancer, with an incidence rate of 1% to 8%. Once paraneoplastic syndrome is triggered by cancer, the mortality rate increases by 47.3%. This article describes a case of a 72 years old ovarian cancer patient with paraneoplastic syndrome and polymyositis. Faced the loss of self-care ability due to the disease, hopelessness, and various negative emotions, which inspire the author's motivation for care. The nursing period is from April 19 to May 7, 2022. Data were collected through interviews, observation, direct care, and cooperated with Gordon's 11 Functional Health Assessment to identify the patient's major health issues, including difficulty in swallowing, impaired physical activity, and hopelessness. During the care process, a strong nurse-patient relationship was initially established, and through interdisciplinary collaboration, an individualized rehabilitation plan was formulated. This plan helped the patient regain her ability to swallow, successfully remove the nasogastric tube, enhance her self-care abilities, increase her sense of control over the disease, lift her hope, and ultimately improve her quality of life. After discharge, the author continued to follow up by telephone for two months, referred the patient to the hospital's cancer case manager to ensure continuous and comprehensive care. It is recommended to create multimedia training materials for swallowing training, provide health education guidance as early as possible, and cooperate with audio-visual respond teaching to obtain sufficient time for discharge preparations and improve the quality of life after returning home. The author hopes by sharing this nursing experience, it will serve as a reference for caring similar cases in the future.