一位初診斷膀胱癌病人術後接受化學治療及戒菸之門診照護經驗

本文探討一位初診斷膀胱癌病人接受尿道膀胱腫瘤切除手術、術後進行膀胱內化療藥物灌注治療，以及戒菸過程的照護經驗。於2021年11月22日至2022年3月21日照護期間，共門診照護9次、電訪9次，運用Gordon十一項功能性健康型態進行評估，經由觀察、會談、身體評估、病歷查閱、電訪及門診照護方式，確立個案有「潛在危險性感染」、「焦慮」及「不遵從」三項護理問題。護理過程中，透過結構式就醫提問單來幫助病人更理解和應對醫療照護過程之個別性護理措施緩解個案焦慮；教導輸尿管導管留置及膀胱內化療藥物灌注治療後日常生活需多喝水、不憋尿及不提重物，避免泌尿感染發生；運用家人的關懷和支持，並結合跨理論模式引導戒菸，提供相應的戒菸衛教諮詢，同時通過智慧手機連接行動社群網路及運動，協助個案成功地實現戒菸目標。建議臨床醫療人員應接受戒菸相關培訓，當辨識初診斷膀胱癌病人中有吸菸者能積極戒菸勸戒及轉介，避免錯過能成功戒菸的行為改變可教時刻。

關鍵字

膀胱癌；戒菸；就醫提問單

並列摘要

This article explores the care experience of a newly diagnosed bladder cancer patient undergoing transurethral bladder tumor resection surgery, postoperative bladder intravesical chemotherapy, and the process of smoking cessation. During the care period from November 22, 2021, to March 21, 2022, a total of nine outpatient visits and nine telephone consultations were conducted. The assessment was carried out using Gordon's Eleven Functional Health Patterns through observations, interviews, physical assessments, medical record review, telephone consultations, and outpatient care methods. Three nursing problems were identified for the case, including "potential risk for infection," "anxiety," and "non-compliance." During the nursing process, a structured medical questionnaire was used to assist the patient in understanding and coping with individualized nursing measures, alleviating patient anxiety. Teaching was provided on postoperative urinary catheter care and intravesical chemotherapy, emphasizing the importance of increased fluid intake, avoiding urinary retention, and refraining from lifting heavy objects to prevent urinary tract infections. Family support was leveraged, and a trans-theoretical model was applied to guide smoking cessation, offering relevant smoking cessation education and counseling. Additionally, the integration of mobile applications connecting to social networks and exercise programs helped the patient successfully achieve smoking cessation goals. It is recommended that clinical healthcare professionals receive training in smoking cessation. When identifying smokers among newly diagnosed bladder cancer patients, healthcare professionals should actively provide smoking cessation advice and referrals to avoid missing the opportunity for behavior change when patients are receptive to quitting.

並列關鍵字

Bladder Cancer ； Smoking Cessation ； Question Prompt List

主題瀏覽