- 期刊
一位智能障礙的胃癌病人接受化學治療之個案管理經驗
A Case Management Experiences for a Mental Retardation Patient Receive Chemotherapy in Gastric Cancer
摘要
個案為一位30歲智能障礙男性病人，初次面臨胃癌診斷與治療的過程。由於個案本身的特殊性及家庭支持系統不足，進而引發筆者探討及照護的動機。筆者於2018年4月25日至2018年6月30日期間採個案管理照顧，運用Gordon十一項功能性健康型態評估，以觀察、會談、身體評估及病歷查閱等方式收集資料，確認主要之健康問題有口腔黏膜改變、噁心嘔吐、營養狀況改變：少於身體需要、家庭因應能力失調等。利用學習策略使輕度智障個案經訓練能具備基本的學習能力參與自我照顧，學會口腔照護能力，減低口腔黏膜破損的不適，採用非藥物處置方法減輕化療引發噁心嘔吐的不適，進而恢復進食的動力。運用個案管理提供個別性衛教，協助緩解生理不適、跨團隊照護及持續性的關懷，減輕主要照顧者焦慮，達到疾病適應及發展疾病因應策略。建議能加強臨床護理師及個案管理師對於特殊個案的認識、溝通與照護技巧教育訓練，藉以提升此類個案整體之照護品質。
並列摘要
This is a case study of the nursing care process for a 30-year old male gastric cancer patient with a mental condition. The particularity of the underlying mental condition of the patient and the insufficient family support motivated the author to do this study . The nursing management was conducted from April 25 to June 30 of 2018. The Gordon's 11 Functional Health Patterns was applied to do the comprehensive nursing assessment of the patient. The main health issues of this patient were revealed to be oral mucosa changes, nausea, vomiting, decreased nutrient intake, and insufficient family response capabilities. By utilizing the learning strategy, the patient was trained to: 1) obtain basic learning skills for self-care; 2) learn oral care skills to relieve mucositis pain; and 3) to use non-drug treatment methods to reduce the discomfort of nausea and vomiting related to the chemotherapy, and thereby resumed his normal appetite. In addition, to help the patient to cope with the disease progression, case management was applied to provide individualized health education, relieve physical discomfort, and reduce the anxiety of the caregivers through multi-disciplinary team consult and continuing care. This study recommends the training for clinical nurses and case managers in understanding, communication, and health care skills for special needs patients to be renewed and implemented so as to improve the overall care quality for patients in similar conditions.