一位肺癌末期併腦轉移病人之護理經驗

Nursing Experience of a Terminal Patient with Lung Cancer and Brain Metastases

莊莉瀅(Li-Ying Chuang) ； 劉曉君(Hsiao-Chun Liu)

《腫瘤護理雜誌》 17卷1期 (2017/06) Pp. 75-86

https://doi.org/10.3966/168395442017061701007

摘要

本篇描述一位中壯年肺癌末期男性，原於香港開立公司，為家中主要決策者及主要經濟來源者，兩名幼子及案妻皆依賴個案，因診斷肺癌且治療未果，攜家返台求醫，護理期間為2014年6月2日至6月23日。筆者藉由觀察、會談、身體評估等方式及運用Gordon十一項健康功能型態評估收集資料，確立個案有潛在危險性傷害、慢性疼痛、照顧者哀傷、家庭運作過程改變等健康問題。護理期間透過降低腦壓、集中照護、安全保護，減少癲癇發作產生的傷害；配合醫療處置，利用熱敷、按摩、穴位按壓、音樂療法及增加家人陪伴，轉移疼痛注意力，達到生理舒適；給予照顧者傾聽、陪伴，以抒發哀傷情緒，運用生命回顧讓照顧者重建希望，正向面對死亡，於安寧共同照護護理師輔助下完成善終事宜；建立幼童死亡概念，鼓勵家庭成員間分享感受、共同分擔家庭責任、調整家庭角色，以回歸正常家庭運作。期望分享此篇個案報告，可提供臨床護理同仁未來照護該類個案之參考。

關鍵字

肺癌 ； 疼痛 ； 哀傷

並列摘要

This paper presents a middle-aged man with terminal lung cancer, who worked in Hong Kong and was the main provider and the decision maker at home. Because of the poor treatment outcome of the lung cancer, he took all his family to Taiwan to seek medical care. The period of nursing care was from Jun.2 to Jun.23, 2014. The analysis of data collected through observation, interview, physical evaluation and Gordon's functional health assessment identified four main problems: risk of injury, chronic pain, caregiver grieving, and interrupted family functions. The nurses decreased intracranial pressure and disturbance to prevent damage, and used hot packing, massage, acupressure, music therapy, and family companionship to shift the attention of pain. We provided listening, companionship, and life reflection to reconstruct caregiver's hope and achieved the good death with hospice care nurses. To facilitate the family function, we introduced the death concept to young children, encouraged family to share their own feelings and responsibilities, and remodeled the roles. This article shares nursing experience for similar patient care.

並列關鍵字

lung cancer ； pain ； grieving

參考文獻

行政院衛生署(2014).民國102年主要死因分析．取自 http://www.mohw.gov.tw/cht/DOS/ Statistic.aspx?f_list_no=312&fod_list_ no=5150 [Ministry of Health and Welfare, Tai- wan, ROC. (2014). 2013 statistics of causes of death. Retrieved from http://www.mohw.gov. tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_ list_no=5150]

宋雅雯、金繼春(2012). 以家庭調整與適應反應模式照顧一個有疾病危機之核心家庭, 嘉基護理,12(1),15-23。[Sung, Y. W., & Chin, C. C. (2012). Using the Family Adjust- ment and Adaptation Response Model to Take Care a Nuclear Family With Crisis. Ditmanson Medical Foundation Chia-Yi Christian Hospi- tal Journal of Nursing. 12(1), 15-23.]

李育萱、江錦玲(2007).一位腦瘤術後併放射線治療個案之護理經驗,志為護理,6(4), 133-143 • [Lee, Y. H., & Jiang, J. L. (2007) Nursing Experience with a Brain Tumor Patient Who Received Craniotomy and Radiotherapy. Tzu Chi Nursing Journal, 6(4), 133-143.]

李婉毓、董道興、師慧娟(2013). Watson 關懷理論於肺癌未期病患之護理經驗,台灣健康照顧研究學刊,15,23-40。[Lee, W. Y., Tung, T. H., & Shih, H. C. (2013). Nursing experience providing terminal care based on Watson s caring theory to a lung cancer patient. The Journal of Taiwan Health Care Associa- tion, 15, 23-40.]

杜明勳(2008).靈性照顧之臨床運用,內科學誌• 19 • 318-324 • [Tu, M. S. (2008). Clinical Application of Spiritual Care. Journal of Inter- nal Medicine of Taiwan, 19, 318-324.]