一位鼻咽癌末期病患之護理經驗

Nursing Experience for a Patient with Late-Stage Nasopharyngeal Cancer

本文是一位鼻咽癌合併多部位轉移的末期病患，除嚴重生理問題外，面臨癌症惡化感受到死亡逼近的護理經驗。照護期間101年12月26日至102年1月15日，藉由觀察、會談、身體評估等方式及運用Gordon十一項功能性健康評估，確認個案有疼痛、營養狀況改變：少於身體所需、死亡焦慮、照顧者角色緊張等問題。筆者運用安寧療護理念，在照護過程中，了解個案對癌症疼痛控制有錯誤的信念，提供正確止痛用藥知識，配合藥物及運用輔助療法來緩解疼痛。在營養缺失透過與家屬持續的溝通，最終提供個案適當的營養支持。此外，運用陪伴、傾聽及支持，提供家屬在癌末病患的照護事宜，減輕個案身體不適症狀；協同安寧共照師介入照護，協助其生命歷程回顧，及面對疾病進展和預期死亡，使其在最後生命歷程達到安適。

This case report describes a nursing experience of a patient with nasopharyngeal cancer combining multiple metastases. In addition to the physiological problems, the patient is confronted with the deterioration of cancer and suffering from the approach of death. During the caring period from Dec 26, 2012 to Jan 15, 2013, the observation, interview, physical assessment, and the Gordon 11-item Functional Health Pattern were used for assessment. The patient's health problems were recognized as pains, altered nutrition: less than body requirements, death anxiety, and caregiver role strain. The author used hospice care principles to provide care proactively. During the care period, the author realized the patient's incorrect concept of pain control and provided genuine knowledge relating to pain relievers instead. In addition, complementary therapy combined with drugs was applied to alleviate pain. Regarding nutrition, there was continual communication with family to provide proper nutrition. Accompanying, listening and support were, provided in order to assist the family in caring for the terminal cancer patient and alleviating the patient's physical discomfort. In addition, a hospice nurse was coordinated to help the patient reflect positively back on her life, to face the disease's progress and anticipate death, and to achieve comfort in the final journey of her life.