照顧一位胸腺癌併左全肺切除病患急性期之護理

Nursing Care for a Thymocarcinoma Patient with Left Pneumonectomy in Acute Stage: A Case Report

本文敘述一位胸腺癌合併肺侵犯之病患，施行左全肺切除術後，在加護病房期間（2003年8月11日至8月14日），筆者經由病史收集、觀察、訪談、行為過程實錄等方式，以生理、心理、社會、靈性四方面來做評估。發現個案在手術後，因面臨生理上嚴重的症狀困擾一呼吸困難，其內心產生焦慮、無望和死亡的威脅。在此筆者利用控制型止痛劑、教導深呼吸技巧和肌肉放鬆技巧等護理措施，來減輕生理層面的術後傷口疼痛及呼吸困難；同時運用社會支持系統來提昇個案自信心，加強自我希望動機，進而減輕心理層面的壓力，並加強個案及家屬的照顧能力，縮短住院天數。This article aims to present the case of a thymocarcinoma patient with lung invasion and received left pneumonectomy. During her stay in ICU (from August 11th to 14th, 2003), medical history, observation, interview, and behavioral process recording were used for data collection. An assessment is offered of the patient’s physical, emotional, social, and spiritual well-being. The author found out the patient suffered from severe dyspnea phenomenon after pneumonectomy. The life-threatening condition made her feel severe anxiety and hopelessness, even to wish death. The author provided nursing interventions such as patient-controlled analgesia (PCA), deep breathing technique, and muscle relaxation to improve her postoperative wound pain, and dyspnea condition. The author also added a social support system to increase her confidence and hope, as well as reduce psychological stress, promote the self-care ability of patient and family, and shorten the length of stay.