【論文摘要】Collaborative Discharge Planning for an Individual With Esophageal Carcinoma and Lung Metastasis

【論文摘要】一位食道癌合併肺轉移病人的團隊出院計畫

陳柏禎(Bo-Jhen Chen)

《物理治療》 45卷2期 (2020/06) Pp. 139-140

https://doi.org/10.6215/FJPT.202006.P06

摘要

Background and Purpose: Patients who are acutely ill often develop functional recline. Effective discharge placement enhances continuing service for both patients and health care practitioners. The process must address real condition and context and available medical resources. We utilized team approach to discharge a patient with lung cancer. Methods: A retired 66-year-old male, with excised esophageal squamous cell carcinoma, was admitted to our hospital due to metastasis to the lower lobe of right lung. He then received wedge lobectomy, laparoscopic enterolysis and later tracheostomy. He lived with his wife at a fourth-floor apartment and anticipated to return to the community. Physical therapy was consulted for cachexia and bedridden state after the surgeries. The intervention comprised sequential breathing exercise, aerobic walking training, and strengthening the appendicular muscles. Nurses implemented family communication and self-monitoring exercises. A dietician also provided tailored nutritional supplements. Results: Total 20 sessions of rehabilitation was completed thrice-weekly for seven weeks. The patient’s oxygen demand improved from aerosol mask (6 L/min) to normal saturation in the room air. His endurance improved from 181-358 m in the Six-Minute-Walk-Test, and readily succeeded to take 4 flights of stairs. The ability to perform functional activities improved from 35-90 on the Barthel Index. He was then discharged home without any environment modification. The nasogastric tube and tracheostomy tube were removed one month after discharge. Conclusion: Although physical impairment was presenting, the patient and his family reported greater satisfaction to therapeutic care. The mutual goals to prior level of function were all achieved. By incorporating multidisciplinary professionals and patients in the discharge plan, the active partnership ensures optimizing outcomes. Clinical Relevance: Delivering collaborative team work would improve the care of transition for those with complex conditions.