一位胰臟癌肝轉移合併惡性腹水病人之臨終照護經驗

本文描述一位82歲男性病人，於2018年7月診斷胰臟癌肝轉移合併惡性腹水，經標靶與化學治療後，於2019年3月，因腹水及肋膜積水導致呼吸喘入院，照護期間為2019年3月11日至4月28日。以Gordon十一項健康功能評估，收集身、心、靈與社會各層面的資料，發現病人主要健康問題為體液容積過量、活動無耐力及預期性哀傷。病人除承受疾病造成的痛苦，還需面臨死亡將近之恐懼，而家屬也同時須面臨親人瀕臨死亡的哀傷。筆者藉由建立良好之護病關係，藉由關懷、陪伴與同理心支持，共同討論、設定目標及擬定照護計畫等，並召開跨團隊會議及會診安寧療護介入，自主引導病人及家屬情緒抒發、幫助病人生命回顧、心靈及家屬之哀傷輔導等護理措施，提升病人臨終前的生活品質，安詳離世。

關鍵字

胰臟癌；肝轉移；惡性腹水

並列摘要

This 82 y/o male was a victim of pancreatic cancer with liver metastasis and malignant ascites, diagnosed in July, 2018. After targeted chemotherapy in March, 2019, he was admitted to our ward due to exertional dyspnea related to ascites and pleural effusion. The hospitalization period was from March 11 to April 28, 2019. Using Gordon's 11 Function Health Patterns, we collected all aspects of information regarding physical activity, mind, spirit and social function. After the above process, active health issues of this patient such as excessive fluid status, physical inactivity and anticipatory grief were established. In addition to the physical discomfort caused by malignancy, this patient also was also forced to face approaching death, and for family members, they also needed to deal with the upcoming sadness caused by departure of their loved one. By establishment of a good relationship between the authors and the patient, loving care, companionship and empathy support were provided during the period of nursing care. Additionally, comprehensive discussion, goal-setting and formulated care plans were introduced during the hospitalization period. Multidisciplinary team meetings were held and hospice nursing interventions were arranged to guide the patient and family members in expressing their emotions. Through the above nursing processes, we helped our patient during his life review and mindfulness, and supported the family members in grief counselling. The ultimate goal was to improve the life quality of the patient before death.

並列關鍵字

pancreatic cancer ； liver metastasis ； malignant ascites

參考文獻

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溫明寰、塗勝翔、呂佩瑾、連靜雯、曾琬婷、林小玲、李重賓(2019)．胰臟癌病人健康相關生活品質．腫瘤護理雜誌，19(2)，37-55。https://doi.org/10.6880/TJON.201912_19(2).03

廖偉智、田郁文、王秀伯(2017)．內視鏡於胰臟癌診斷與治療之角色．台灣醫學，21(4)，374-378。https://doi.org/10.6320/FJM.2017.21(4).5

國際替代計量

一位胰臟癌肝轉移合併惡性腹水病人之臨終照護經驗

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