協助腦瘤重症病人歷經急性照護轉緩和療護之照護經驗

本文描述一位26歲罹患星狀細胞瘤復發合併抽搐個案，因病情無法治癒由急性照護轉為緩和療護照護之加護照護經驗。護理期間為2013年1月25日至2月15日，針對生理、心理、社會及靈性進行系統性評估，藉由直接觀察及家屬會談等方式，確立個案健康問題有：潛在危險性損傷、現存的皮膚完整性受損、預期性哀傷等健康問題。照護重點在急性顱內壓過高時，採集中式護理、頭頸保持一直線，密切監測輸入出量，處理尿崩症，維持輸入出量及電解質平衡；當病人病情不可逆時，提供緩和療護照護，與家屬共同討論撤除維生醫療，醫療團隊透過傾聽、關懷、及同理，陪伴家屬渡過撤除過程，協助病人善終，期本文的團隊照護經驗可以提供日後加護病房照護撤除維生醫療病人之參考。

關鍵字

加護病房；撤除維生醫療；腦瘤

並列摘要

This article describes the transition for a 26-year-old patient with recurrent astrocytoma combined with seizure from acute care to palliative care due to the incurability of the condition. The period of care was from January 25, 2013 to February 15, 2013. Systematic assessment included physical, psychological, social and spiritual aspects. By direct nursing observation and family interviews, health problems that were identified included potential risk of injury, existing skin integrity damage, anticipated grief and other health problems. The focus of care during the intracranial hypertension phase was to do cluster care, maintain a straight position of the head and neck, closely monitor the patient's intake and output, and maintain electrolyte balance. When the patient's condition deteriorates leading to organ failure, the focus is to provide palliative care and discuss with their families the possibility of withdrawal of life-sustaining treatments. The medical team accompanied the patient and family through the removal process through listening, caring and empathy. The experience presented in this article could provide a reference for future care in the intensive care unit regarding patients with removal of life support.

並列關鍵字

intensive care unit ； withdraw of life-sustaining treatments ； brain tumor

參考文獻

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林筱菁、許晉豪、張簡志炫、楊正三（2016）．不同的皮膚照護方案對成人失禁性皮膚炎之改善成效：系統性文獻回顧．南台灣醫學雜誌，12（2），103-114。doi:10.6726/MJST.201612_12(2).0007

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馬瑞菊、蔡惠貞（2013）．提供重症善終服務：改善加護病房生命末期照護．馬偕護理，7(1)，7-13。doi:10.29415/JMKN.201301_7(1)0001

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協助腦瘤重症病人歷經急性照護轉緩和療護之照護經驗

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