一位肺癌末期病患之護理經驗

Nursing Experience Caring for a Terminal Stage Patient with Lung Cancer

陳黎雯(Li-Wen Chen) ； 陳綱華(Kang-Hua Chen)

《中山醫學雜誌》 22卷4期 (2011/12) Pp. 475-484

https://doi.org/10.30096/CSMJ.201112.0008

摘要

本篇報告在描述一位接受化學治療的肺癌末期病患，入院時，除了面臨疾病造成的身體不適，包括疼痛興營養下良外，還包含化療造成身體外觀改變，以及面臨生命最後旅程產生之哀傷反應等問題。筆者於2009年12月5日至2010年1月10日護理期間，以Gordon十一項功能性健康評估工具為指引，運用觀察、會談、身體評估及病歷查閱等方式收集資料，確定個案護理問題為疼痛、營養少於身體所需、身體心像改變與預期性哀傷。住院期間提供疼痛醫療處置，配合非藥物照護措施轉移注意力、促進舒適；藉由提供高熱量、高蛋白之癌症飲食衛教，維持身體基本代謝需求；照護期間在安寧共照師協助下，讓個案藉由生命回顧、社會支持及宗教信仰，並傾聽個案心中感受，降低哀傷反應；也透過肺癌病友經驗分享，重新建立對自我身體心像的正向看法，讓個案在治療過程中獲得個別性的整體照顧，提升生命品質。期望藉此個案報告，提供臨床護理人員在照顧此類病患具個別性且適當之照護。

關鍵字

肺癌 ； 疼痛 ； 營養不良 ； 身體心像改變 ； 預期性哀傷

並列摘要

This article describes the experience providing nursing care for a terminal stage lung cancer patient suffering from physical pain and psychological disturbances. Using Gordon functional health patterns as a guide, the authors collected and assessed data through observations, interview, physical assessment, and chart review from December 5 in 2009 to January 10 in 2010. The patient's health problems were recognized as pain, reduced appetite, body image disturbance, and anticipatory grieving. The nurses provided the patient with individualized nursing care including teaching her non-analgesic methods of pain control and imparting knowledge regarding the consumption of high calorie and high protein foods. During the care period, the nurse helped coordinate a hospice nurse for her, helped help her positively back on her life, facilitated family and peer support, and helped her look for religious support upon her request. By listening empathetically to the patient and sharing the experiences of other patients, the nurses decreased the patient's grieving and increased positive thinking about her body image. We hope this article can serve as a reference for other nurses caring for terminally ill patients.

並列關鍵字

lung cancer ； pain ； malnutrition ； body image disturbance ； anticipatory grieving