一位肝癌末期骨轉移病人個案之護理經驗

Caring for a Patient with Terminal Liver Cancer and Bone Metastasis

方姵文(Pei-Wen Fang) ； 蔡宜蓁(Yi-Tseng Tsai)

《長庚護理》 29卷3期 (2018/09) Pp. 456-466

https://doi.org/10.6386/CGN.201809_29(3).0011

摘要

本文描述一位肝癌末期骨轉移病人面臨身體疼痛不適及自我照顧能力喪失之護理經驗。護理期間自2017年3月16日至4月2日，經由會談、身體評估、觀察及直接照護等方式收集資料，運用Gordon十一項健康功能型態評估進行整體性評估及資料整合分析歸納，確立個案有疼痛、體液容積過量及無望感等健康問題。護理過程中提供舒適擺位、穴位指壓及芳香療法，緩解其疼痛不適；教導指壓按摩、控制低鈉限水飲食及嚴密監測輸出入量等，改善體液容積過量問題；運用懷舊療法與家庭支持，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，降低對癌末預後衍生的無望感受。建議醫護同仁重視癌末病人之靈性需求，協助其疾病適應及身心安適，使其能獲得適切性照護，期望經此照護經驗分享，以供臨床實務參考之用。

關鍵字

肝癌 ； 疼痛 ； 體液容積過量 ； 無望感

並列摘要

This paper described the experience of caring for a patient with terminal liver cancer and bone metastases who experienced physical pain and discomfort and loss of self-care ability. The care period was from March 16 to April 2, 2017, and data were collected using interviews, physical assessments, observations, and direct care. A comprehensive evaluation and data integration, analysis, and organization were performed using Gordon's 11 functional health patterns, establishing that the patient had pain, fluid volume excess, and sense of hopelessness. During the caring process, comfortable positioning, acupressure, and aromatherapy were used to relieve pain and discomfort. The patient was instructed in acupressure massage and in controlling a low-sodium diet with fluid restriction, as well as close monitoring of intake and output to mitigate the problem of fluid volume excess. Reminiscence therapy and family support were used to assist the patient with adapting to changes in the disease and strengthening mindfulness, affirming self-worth and reducing the sense of hopelessness caused by terminal cancer. Medical care providers are recommended to pay attention to the spiritual needs of patients with terminal cancer, and to assist them in adapting to the disease as well as attaining physical and mental comfort, thereby ensuring that the patients can receive appropriate care. This care experience is shared as a reference for use in clinical practice.

並列關鍵字

liver cancer ； pain ； fluid volume excess ； sense of hopelessness

參考文獻

李梅琛、梁嘉德、李釙汾、王芳婷(2012)。肝癌局部治療及其照護。腫瘤護理雜誌。12(1)，19-29。

邱婉婷、王素鴻、李國箴(2013)。運用安寧療護理念於肝癌末期病人之護理經驗。澄清醫護管理雜誌。9(4)，54-63。

吳曉玟、謝春金(2014)。一位肝癌末期個案面臨死亡焦慮之護理經驗。志為護理─慈濟護理雜誌。13(1)，90-100。

林錦成(2010)。目前台灣地區肝癌流行與醫療趨勢。北市中醫會刊。16(3)，75-96。

林麗如、陳素燕(2011)。照顧一位肝癌末期患者之照護經驗。腫瘤護理雜誌。11(1)，49-60。