- 期刊
一位初次罹患肝癌合併腫瘤破裂患者之護理經驗
Nursing Experience of a Newly Diagnosed Hepatocellular Carcinoma Patient with Tumor Rupture
摘要
本文描述一位初次診斷肝癌合併腫瘤破裂患者的護理經驗。照護期間為2014年3月28日至4月4日，運用Gordon十一項功能性健康模式進行評估，經由觀察、訪談、紀錄方式收集資料，確立個案有疼痛、危險性出血、個人因應能力失調及知識缺失護理問題。個案面對首次罹癌合併出血需緊急接受經肝動脈栓塞術治療，引發生理症狀癌症初次診斷衝擊，需醫護人員協助建立疾病認知及調適心理衝擊。在護理過程中，運用同理心和關懷與個案及家屬建立信任之護病關係，教導個案運用非藥物疼痛控制技巧緩解腹部疼痛；指導肝癌日常活動及飲食衛教，避免肝臟腫瘤再次出血；因初次罹癌及擔憂疾病進展造成之情緒困擾，給予心理支持，引導其抒發情緒，協助以正向思考及適當之因應技巧面對疾病壓力；依其個別性之需求，提供相關照護資訊，增加對肝癌照護的認知，經由轉介個案管理師諮詢與收案，追蹤其後續情況，以提供病程完整性照護。建議臨床照顧初次診斷癌症及同時面對治療的患者時，同理其所面臨之雙重壓力感受，並提供跨醫療團隊之相關資源，給予適切及連續性照護計畫，以協助患者調適疾病帶來的身心衝擊。
並列摘要
This article describes the nursing experience of a newly diagnosed hepatocellular carcinoma case with tumor rupture. The duration of nursing care was from March 28th to April 4th, 2014. The author used Gordon's 11-Item Functional Health Assessment Model, and collected the data through observations, interviews, records, and confirmed that the case had the following nursing problems, including pain, high-risk bleeding, ineffective coping and lack of knowledge for personal care. The patient suffered from physical, psychological and spiritual distress facing the first emergent invasive treatment after the diagnosis of cancer, and required establishment of the perception of disease knowledge and adjusting psychological impact. The author established a trust relationship with empathy and caring, taught the patient about non-pharmacological techniques to alleviate abdominal discomfort, and provided health education for daily activities and diet to prevent re-bleeding of the liver tumor. We gave psychological support and guided the newly diagnosed carcinoma patient to release the emotional distress; helped her face stress via positive thinking and appropriate coping skills according to individual needs; provided associated information for increasing cognition of hepatocellular carcinoma; and made referral to case managers for providing comprehensive care during the process of follow-up. The author suggests that more compassion be provided for the double pressure of patients just diagnosed with cancer and facing medical treatment, as well as resources of medical team care and continuous care be provided to assist the patient in adjusting to the physical and psychological impacts.