一位威廉氏腫瘤併發肺轉移兒童術後之加護護理經驗

Postoperative Intensive Nursing Care of a Child with Wilms' Tumor Complicated by Pulmonary Metastasis

林秀玟(Hsiu-Wen Lin) ； 曾麗卿(Li-Ching Tseng)

《源遠護理》 5卷2期 (2011/11) Pp. 72-80

https://doi.org/10.6530/YYN.2011.5(2).10

摘要

面臨癌症轉移需要接受手術治療，對病童與家屬而言，身體所承受的病痛與心理所承擔的壓力，皆是不可言喻的，因此，如何協助病童與家屬面對疾病與治療過程中的威脅相當重要。本文是描述一位學齡前期兒童因罹患威廉氏腫瘤併發肺轉移而行肺葉切除手術的加護護理經驗。護理期間自2009年5月20日至5月26日，以Gordon十一項功能性健康型態為評估工具，運用觀察、開放式會談、身體評估及病歷查閱等獲得資料加以分析，確立個案有⑴低效性呼吸型態／與肺葉切除手術有關；⑵恐懼／與醫療處置及案母分離有關；⑶疼痛／與手術傷口及侵入性治療有關；⑷照顧者無力感／與個案病情變化及對未來的不確定感有關。藉由以家庭為中心的護理理念彈性開放會客時間及治療性遊戲的介入，協助個案降低對醫療的恐懼。期望藉此護理經驗，提供護理同仁日後照顧此類病童之參考。

關鍵字

學齡前期兒童 ； 加護護理 ； 威廉氏腫瘤 ； 肺葉切除手術

並列摘要

This article describes the one-week intensive care unit nursing experience of a preschooler post lobectomy due to pulmonary metastasis of Wilms' tumor. Patient information was collected through observation, interview, physical assessment and medical records. Data analysis using Gordon's Module identified four problems: (1) ineffective breathing pattern, related to post lobectomy, (2) fear, related to medical treatment and separation from his mother, (3) pain, related to surgical wounds and invasive treatment, and (4) caregiver powerlessness, related to changes in patient's condition and uncertain prognosis. Family and their children with cancer metastasis that require surgical intervention experience tremendous physical and psychological pain and stress. As part of family-centered care, nursing interventions included therapeutic play and flexible visiting hours to decrease fear.

並列關鍵字

preschooler ； intensive nursing care ； Wilms' tumor ； lobectomy