照顧一位胰臟癌患者接受手術治療術後之護理經驗

Nursing Experience of Caring for a Pancreatic Cancer Patient after Surgery

林邑璇(Yi-Hsuan Lin) ； 黃月芳(Yueh-Fang Huang) ； 陳曉梅(Hsiao-Mei Chen) ； 方俊慧(Chun-Hui Fang)

《澄清醫護管理雜誌》 18卷1期 (2022/01) Pp. 70-79

摘要

本文描述照護一位28歲女性因低血糖昏迷，進而診斷罹患胰臟癌，接受外科手術治療後，面對生理上的不適及心理衝擊產生無望感之護理經驗。護理期間自2019年6月12日至2019年6月22日，透過直接照護、觀察、會談及身體評估收集資料，運用Gordon十一項功能性健康型態進行整體性評估，確立個案有急性疼痛、消化道活動功能失常及無望感三項護理問題。於護理過程中，透過教導傷口固定及漸進式活動，並協助舒適擺位，教導轉移注意力技巧，配合自控式止痛劑使用，緩解疼痛感；透過飲食衛教，指導採少量多餐，補充水份及適當電解質攝取，教導並協助按摩腹部，促進腸胃蠕動，並鼓勵個案下床活動，緩解腹脹噁心感，消化道功能恢復，可進食。採取主動關懷，告知病情治療方向，鼓勵主動參與治療計畫，協助心理調適，引導正向思考，給予正向回饋及鼓勵家屬支持，改善無望感。建議在照顧此類病人時，可以運用多媒體工具，利用照片及影片，強化正確照護知識，獲得更完善的資源，並配合個管師追蹤及後續門診聯繫，給予整體性的照護。

關鍵字

胰臟癌 ； 無望感 ； 護理經驗

並列摘要

This paper describes the nursing experience of caring for a 28-year-old woman who experienced a hypoglycemic coma and was subsequently diagnosed with pancreatic cancer. After surgical treatment, she felt hopeless due to physical discomfort and the psychological impact of the diagnosis. During the nursing period from June 12 to June 22, 2019, data were collected through direct care, observation, interviews, and physical evaluations, and Gordon's Eleven Functional Health Patterns were used for the overall assessment. Three nursing problems were identified, namely acute pain, digestive tract movement dysfunction, and hopelessness. In the nursing process, through teaching wound fixation and progressive activities, assisting with comfortable positioning, teaching distraction skills, and combining patient-controlled analgesics, the patient's pain was relieved; through diet and health education, the instruction to take several small meals a day, supplement with water, and consume proper amounts of electrolytes, teaching and assisting with abdominal massage, promoting gastrointestinal peristalsis, and encouraging the patient to get out of bed for activities, her abdominal distension and nausea were relieved, her digestive tract function was restored, and she became able to eat. Active care consisted of informing the patient of the treatment direction, encouraging her to actively participate in the treatment plan, assisting with her psychological adjustment, guiding positive thinking, providing positive feedback, and encouraging family support, and her hopelessness was alleviated. This case suggests that in the care of such patients, multimedia tools, photos, and videos can be used to strengthen the patient's correct care knowledge, while case manager follow-up and subsequent outpatient contact can be combined to provide holistic care.

並列關鍵字

Hopelessness ； Nursing experience ； Pancreatic cancer