照顧一位慢性阻塞性肺疾病合併結腸腫瘤手術病人之護理經驗

The Nursing Experience for a Patient with Chronic Obstructive Pulmonary Disease Coexisted with Colon Tumor

本文主要為描述一位慢性阻塞性肺疾病合併呼吸衰竭的病人，在住院期間意外發現有結腸腫瘤並接受手術，於病情穩定後由加護病房轉出至病房的護理經驗。護理期間自2012年9月15至9月23日，因個案疾病所帶來的失能且個案病況未穩定，照顧者倍感照護壓力而產生緊張、焦慮等問題，透過Gordon十一項健康功能評估發現，個案除了因疾病造成了呼吸道清除功能失效及營養少於身體需要問題外，明顯有照顧者緊張之問題出現。經由筆者計劃性護理，其呼吸道痰液能得已排出，並每日執行胸腔復健運動以維持肺功能，漸進式恢復經由管灌來提供足夠以維持身體所需的營養，並透過與家屬共同擬定計劃，使家屬對個案的照顧有參與感，減少對照顧技術的焦慮，進而維持良好的照顧品質，藉以提供臨床人員照護此類個案之參考。

This article describes the nursing experience of a chronic obstructive pulmonary disease (COPD) with respiratory failure patient receiving a colonic surgery when discovered accidentally of colon tumor during hospitalization; the patient was then transferred out of the intensive care unit (ICU) after stabilization. During the caring period, from September 15th to September 23rd, 2012, caregiver demonstrated symptoms of stress and anxiety due to the disability and unstable condition of the patient. The author applied Gordon’s 11 Functional Health Patterns Assessment to identify the primary problems of this case and discovered that apart from illness-related problems such as ineffective airway clearance and altered nutrition (less than body requirements), the mental strains of the caregiver role have also became an issue. Through nursing care interventions, the author assisted and trained the patient to clear mucus in the respiratory tract himself, develop exercise training in pulmonary rehabilitation in sustaining lung function, and gradually improve the nutritional status of patient by using tube feeding. By discussing a care plan with patient’s family, the caregiver was educated care techniques to ease caregiver’s strain and anxiety, and gently developed a sense of involvement and continuously maintained a high quality of care. We would like to share the care experience as a reference for the nursing staff who encounter similar difficulties in the future.