照護一位肝腫瘤合併骨轉移疼痛患者之護理經驗

Nursing Experience of Pain Control for a Hepatocellular Carcinoma Patient with Bony Metastasis

樊君儀(Chun-I Fan) ； 蔣曉文(Hsiao-Wen Chiang)

《腫瘤護理雜誌》 5卷2期 (2005/12) Pp. 77-89

https://doi.org/10.6880/TJON.200512_5(2).07

摘要

本文是探討一位肝癌合併股骨轉移個案，雖然病程中並未出現黃疸、腹水及腹部脹痛之肝癌典型症狀，但是卻因為嚴重的骨疼痛，導致喪失自我照顧能力，因而對人生產生悲觀及無望感，同時案妻因個案之疼痛無法緩解，而出現不知所措、無助及哭泣等情緒。護理期間為93年5月1日至93年5月11日，住院期間筆者採用觀察、會談、身體評估及疼痛評估技巧，並運用歐倫自我照顧理論系統(Orem's Self Care System)，評估個案的自我照顧能力及自我照顧缺失，發現個案有1.疼痛，2.自我照顧能力缺失：日常生活照顧，3.潛在損傷，4.無力感4項主要健康問題。筆者透過與醫療團隊及家屬的討論，擬定護理計劃，優先調整止痛藥物之給予，輔以非藥物之疼痛控制方法，並指導個案及家屬使用止痛藥物之用法及正確觀念，增加個案對疼痛控制的信心，同時提供部分代償及支持性教育護理措施以協助個案發揮身體最大功能，增進自我照顧能力，提昇個案及整個家庭之生活品質。

關鍵字

疼痛 ； 疼痛控制 ； 歐倫自我照顧系統

並列摘要

The subject of this study is a 50-year-old hepatocellular carcinoma (HCC) with bony metastasis male who, although displaying none of the typical symptoms of jaundice, ascites, and abdominal pain, lost the ability of self-care due to severe bone pain. The result is pessimistic and hopeless lives for both his wife and himself. Inpatient nursing care was offered from May 1, 2004 to May 11, 2004. During this time period, observations, interview, and physical examinations were used to assess the intensity of his pain. Orem's Self Care System was used to evaluate his capacity for self-care. The problems found are: 1. ill-managed pain, 2. self-care deficit and 3. rish for injury 4. Despair. Through discussions with the therapeutic team and his family, a specific nursing-care plan was formulated. The aim was pain control by medical and non-medical modalities, such as adjusting the administration of analgesics and emphasizing the correct methods and concept of taking analgesics as well as establishing his confidence in pain control. To prevent the injury complicated by bony metastasis and radiation therapy, we provided protective device for his lesions at limb and skin. This way, his maximal physical function, ability of self-care and improvement of quality of life can be achieved.

並列關鍵字

cancer pain, pain control ； Orem's Self Care System