照護一位大腸癌腫瘤壓迫引發腎盂腎炎合併敗血性休克個案之加護經驗

Experience of care a Patient with colorectal-cancer tumor caused pyelonephritis and septic shock due to ureteral compression

林怡婷(Yi-Ting Lin) ； 詹効儒(Hsiao-Ju Chan) ； 王于嘉(Yu-Chia Wang) ； 李佳玲(Chia-Lin Lee)

《彰化護理》 27卷2期 (2020/06) Pp. 95-109

https://doi.org/10.6647/CN.202006_27(2).0013

摘要

本文描述一位73歲女性，因大腸癌腫瘤壓迫輸尿管引發腎盂腎炎合併敗血性休克之加護經驗。筆者於2016年9月12日至9月21日護理期間，運用Gordon十一項健康功能型態做為評估架構，透過身體評估、會談、觀察及傾聽等方式收集資料及進行整體性評估，在照護過程中發現個案有現存性感染問題、疼痛、焦慮之健康問題。藉由個別性、獨特性之護理，包括：（1）敗血症復甦組合式照護、感染控制原則改善現存性感染問題（2）運用穴道按壓、音樂治療等輔助療法來減輕疼痛不適（3）透過跨團隊照護模式建立信任的護病關係，藉由傾聽、陪伴、宗教信仰及精油按摩促使個案放鬆及增加安全感（4）安排癌症個管師持續監測、評值及追蹤，以避免擔心未來發展，進而減輕焦慮情緒；個案因面臨病情惡化而入住加護病房而引起其內心極大的衝擊，使得個案產生不安、焦慮等情緒，因此引發筆者想深入探討及分享此次照護的動機，期望經驗分享，能提供照護人員相關照護之參考，進而提升照護品質。

關鍵字

大腸癌 ； 腎盂腎炎 ； 敗血性休克 ； 焦慮

並列摘要

This study described the experience of a 73-year-old woman who received intensive care because her colorectal-cancer tumor caused pyelonephritis with septic shock due to ureteral compression. The nursing period was from 2016/9/12 to 2016/9/21 and the nurse carried out observations, conversations, listening, physical assessments in order to collect data. On applying the eleven functional health patterns as described by Marjory Gordon, it was found that the nursing assessment clarified certain nursing issues including existing infection, pain, and anxiety. Individualized care was provided to this woman, including (1) providing the sepsis management care bundle and applying infection control to improve existing infection; (2) using acupoint massage and musical therapy to relieve pain and discomfort; (3) adopting a cross-team care model to establish a trusted nurse-patient relationship and employing listening skills, accompanying methods, religious beliefs, and essential oil massage to help the client relax and enhance her sense of security; (4) arranging a cancer case manager to monitor, assess, and follow up the case and providing subsequent care to alleviate anxiety in the client. The patient was admitted to the intensive care unit soon after her condition worsened, This had a substantial impact on the patient´s psychological state and induced distress and anxiety. As a result, discussion and sharing of the motivation of nursing experiences with this case in order to provide more information to our profession on caring in such a situation.

並列關鍵字

colorectal-cancer ； pyelonephritis ； septic shock ； anxiety

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