肺癌病人首次化學治療不慎藥物外滲之照護經驗

Care Experience of a Lung Cancer Patient Developing Extravasation during First Chemotherapy

黃婕榕(Jie-Rong Huang) ； 黃姿菁(Zih-Jing Huang) ； 杜慧茹(Huei-Ru Du) ； 陳宜欣(Yi-Shin Chen) ； 蔡宜蓁(Yi-Tseng Tsai)

《長庚護理》 28卷4期 (2017/12) Pp. 665-676

https://doi.org/10.3966/102673012017122804008

摘要

本文探討一位肺癌首次接受化學治療的老年女性，化療期間不慎拉扯管路導致藥物外滲不良反應，併發身心不適及難以預測病情變化衍生無望感之照護經驗。筆者於2015年9月2日至11月19日，利用觀察、會談及身體評估等技巧收集資料，運用Gordon十一項功能性健康型態行整體性系統評估，發現病人出現焦慮、皮膚完整性受損及無望感等問題。護理期間運用關懷陪伴建立信任護病關係，使其瞭解診療計畫及提供化學藥物相關資訊，增加對疾病控制感，以減輕其焦慮不安；針對皮膚外滲損傷成立醫療關懷小組，提供傷口照護及後續追蹤，以降低外滲傷害；協助病人適應疾病變化及增強正向信念，肯定自我存在價值，降低罹癌衍生的無力感。建議醫護同仁加強病人及照顧者肺癌化學治療居家照護技能，使其身、心皆獲得適切性照護及降低肺炎感染風險，期望經此照護經驗分享，以供臨床實務參考之用。建議醫護同仁重視癌症病人發生化療外滲之緊急應變措施及返家照護技能，使其身、心獲得適切性照護及降低外滲傷口感染風險，期望經此照護經驗分享，以供臨床實務參考之用。

關鍵字

肺癌 ； 化學治療 ； 外滲

並列摘要

This study reported the care experience of an older woman with lung cancer undergoing chemotherapy for the first time, during which an intravenous line was accidentally pulled, causing extravasation and leading to adverse reactions. The condition was complicated by psychophysical discomfort, which along with unpredictable changes caused a sense of hopelessness in the patient. Data were collected from September 2 to November 19, 2015 through observation, interviews and a physical assessment. Gordon's 11 functional health patterns were used to perform an overall health assessment; anxiety, impaired skin integrity, and feelings of hopelessness were observed in the patient. Care and companionship were employed to establish trust in the nurse-patient relationship. The nursing team explained the treatment plan and provided chemotherapy drug-related information to the patient to enhance her sense of control over the disease and to reduce her anxiety. A health care team was formed to treat the extravasation wound and provide follow up to reduce skin damage. The team helped the patient adapt to changes in the disease, boost her optimism and confidence in her self-worth, and reduce her sense of powerlessness arising from the cancer. The author recommends that health care professionals enhance the lung cancer chemotherapy home care skills of the patient and her caregiver so that the patient can receive appropriate physical and mental care and to reduce the risk of pneumonia. The author also recommends that health care professionals emphasize emergency measures for extravasation in cancer patients in addition to home care skill, so that patients can receive appropriate physical and mental care and so that the risk of infection of the extravasated area can be reduced. This experience may serve as a reference for clinical practice.

並列關鍵字

lung cancer ； chemotherapy ； extravasation

參考文獻

王新芳、黃秀英、祝孔聖、王傳育、馬君、王良順、彭汪嘉康Jacqueline, W. P.(2013)。利用根本原因分析（Root Cause Analysis, RCA） 改善化療藥物外滲事件。醫療品質雜誌。5(1)，5-64。

宋怡珊、周寶鈺、陳可欣(2015)。照護一位初次診斷卵巢癌婦女首次接受化學治療之護理經驗。嘉基護理。15(2)，22-31。

林雅萍、羅樺鈴、巫怡翎、曾斐琳(2015)。照顧一位肝癌末期病人之護理經驗。長庚護理。26(2)，203-213。

邱惠英、林佑樺、王金洲、陳婉宜、張晃智、林孟志(2016)。肺癌化學治療後病人照護需求與相關因素之探討。護理雜誌。63(3)，62-72。

施穎銘、陳育民(2009)。非小細胞肺癌手術後輔助性化學治療。內科學誌。20(6)，490-496。