一位罹患腎細胞癌患者接受根除性全腎切除術之護理經驗

An Experience ofNursing Care for a Renal Cell Carcinoma Patient who Received Radical Nephrectomy

本篇報告是描述一位65歲男性病人罹患腎細胞癌而接受單側根除性全腎切除手術後所經歷的生理、心理衝擊之照護經驗。筆者於2011年4月7日至4月14日護理過程中，應用溝通、觀察、身體檢查、及Gordon健康功能型態評估架構進行資料收集及分析，呈現個案在住院過程中有急性疼痛、焦慮及睡眠型態紊亂等健康問題。照護期間，筆者與病人及家屬建立良好的護病關係，主動關懷、傾聽，鼓勵個案表達感受，且提供個別及整體性的護理計劃，教導家屬協助個案背部及肢體按摩，藉此放鬆技巧來減緩術後疼痛；運用心理支持及護理指導以降低個案焦慮的情緒；此外，依照個案的睡眠習慣安排入睡環境，以利改善失眠之健康問題。護理期間個案漸進能以正向態度面對此次重大手術的衝擊，增強自我控制感，術後穩定並出院返家。期望藉此照護經驗之分享，能提供護理人員照護相關個案的參考。This article is to describe the experience of nursing care for a 65 year-old elder suffering from the renal cell carcinoma, who experienced physical and psychological challenges from receiving radical nephrectomy. The period of nursing care was from April 7th to April 14th in 2011. The authors collected data through interview, observation, physical examination and application of Gordon's functional health patterns assessment guidelines for analysis. The results showed that the patient's health problems include acute pain, anxiety, and sleep disturbance. Through a good nursing-patient relationship, the authors and the family listened and encouraged the patient to express his feelings. They also provided the individual and holistic care plan, and instructed the family with relaxation techniques to massage the back and limbs of the patient in order to relieve the postoperative acute pain. In addition, the authors offered emotional support and health instructions to mitigate the anxiety of the patient. Furthermore, the sleeping environment was arranged according to the habit of the patient to improve his sleeping condition. Through the individual and holistic nursing process, the authors helped the case to positively face the progress of the radical nephrectomy. We hope to provide the nursing staff with this experience as a reference when taking care of similar cases.