一位年輕女性罹鼻咽癌接受同步放射化學治療之護理經驗

A Nursing Experience of a Young Female with Nasopharyngeal Carcinoma Undergoing Concurrent Chemoradiation Therapy

本文主要描述一位34歲初產婦，在生產後滿月，即被診斷鼻咽癌之照護經驗。病人除面臨到癌症的威脅及治療的副作用，更需面對親子分離的調適，引起書寫本文動機。護理期間為2012年3月24日至2012年4月23日，入院行第二次同步放射化學治療(concurrentchemo-radiotherapy, CCRT)，筆者以羅氏適應模式做為整體性評估，以直接照護、觀察及會談方式收集資料，發現個案之護理問題為口腔黏膜改變、身體心像紊亂、親職角色衝突。透過與病人建立關係，依病人個別性需求，提供舒適護理、護理指導及相關資源，促進個案口腔黏膜修復，並能面對自己身體外觀的改變，最後與病人共同討論住院期間及出院後親子計畫，調適目前之角色，以面對未來生活。

This article described the nursing experience of a 34-year-old primigravida who, one month after delivery, was diagnosed with nasopharyngeal carcinoma. The patient, confronted with the threat of cancer and therapeutic side effects, had to adapt to parent-child separation as well, which prompted this study The nursing period lasted from March 24th to April 23rd 2012, during which the patient was hospitalized for her second concurrent chemoradiation therapy. Roy's Adaption Model was applied to perform a comprehensive assessment, and the data were collected by direct caring, observation, and interviews. The patient's problems were identified as impaired mucous membrane caused by concurrent chemoradiation therapy, body image disturbance, and parental role conflict. To address these issues, the following interventions were implemented: establishing a good nurse-patient relationship; providing comfortable nursing care, nursing instructions, and relevant resources to facilitate the healing of the mucous membrane and adaptation to the alteration of body image; and finally discussing parental planning during and after hospitalization. Once these interventions were implemented, the patient adapted to her current role and was ready to face the future.