照顧一位青壯年鼻咽癌末期病人之護理經驗

Nursing Experience of A Young Terminal Patients with Nasopharyngeal Carcinoma

蕭淑華(Shu-Hua Hsiao) ； 謝佩琪(Pei-Chi Hsieh) ； 蕭嘉琪(Chia-Chi Hsiao)

《長庚護理》 28卷4期 (2017/12) Pp. 686-697

https://doi.org/10.3966/102673012017122804010

摘要

本文描述一位青壯年鼻咽癌末期病人面臨身心靈衝擊之護理經驗。護理期間為2015年5月1日至5月20日，病人在住院前日常生活皆可自理，此次因腦部及骨轉移，癌痛無法控制，合併右側肢體無力致日常生活需倚賴太太，並擔心死後子女養育問題，故產生焦慮症狀，引發筆者深入瞭解動機。依生理、心理、社會、發展及靈性層面進行整體性評估，確立病人有「疼痛」、「營養少於身體需求」、「身體活動功能障礙」及「死亡焦慮」之健康問題。運用醫療團隊合作，擬定疼痛控制計畫，改善癌症骨轉移疼痛；依據喜愛規劃訂定飲食餐，使熱量攝取達身體所需；按照復健計畫安排及鼓勵方式，增進身體活動意願以提升自我照護；憑藉信仰力量，引導說出內心感受，並運用生命回顧了解生命意義及自我價值，以緩解死亡焦慮。本院安寧療護居家訪視尚在規劃籌備，故在出院後以電訪追蹤，了解家屬及病人照護能力，期許及建議能結合居家安寧訪視，以提升癌末病人照護品質。

關鍵字

鼻咽癌 ； 護理經驗 ； 青壯年病人 ； 生命回顧法

並列摘要

This paper describes the care provided to a young adult patient with end stage nasopharyngeal cancer. Care was provided from May 1 to May 20, 2015. The patient was able to function normally before hospitalization; however, as the cancer metastasized to the brain and bones, the patient was unable to manage the pain. Right-sided hemiparesis caused the patient to rely heavily on his wife which also made him worry about caring for their children. This resulted in symptoms of anxiety. Collection and analysis of physiological, psychological, social, developmental, and spiritual data confirmed that the patient suffered from pain, malnutrition, impaired physical function, and death anxiety. In cooperation with the medical team, a pain management plan was drafted to improve the bone metastasis pain. A dietary plan was also formulated using foods the patient enjoyed to ensure sufficient calorie intake. Rehabilitation and encouragement were used to improve the patient's willingness to engage in physical activity and ability for self-care. Spiritual beliefs were used to help express emotions and reminiscence therapy helped understand the meaning of life in order to relieve death anxiety. As hospice care at this hospital does not include home visits, follow-up was conducted via telephone to understand the family’s and patient's ability for self-car. It was suggested that the patient make use of home hospice care to improve end stage quality of care.

並列關鍵字

nasopharyngeal cancer ； nursing experience ； young adult patient ； reminiscence therapy

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