一位癌末病人突發心肌梗塞面對死亡焦慮之加護經驗

Intensive Nursing Care Experience about a Patient with Terminal Cancer who Suffered from Sudden Myocardial Infarction and Death Anxiety

本文描述一位鼻咽癌末期病人於病房內化療時發生急性心肌梗塞造成心跳休止，診斷心因性休克轉至加護病房，因病情嚴重度高且經歷死亡，對於疾病發展衍生出死亡焦慮，2018/3/10~3/16照護期間以羅氏適應模式為護理架構，進行訪談、觀察及身體評估收集資料，分析歸納出個案有心輸出量減少、急性疼痛及死亡焦慮健康問題，筆者藉由引導個案表達對疾病心理壓力與感受、提供相關文獻讓個案適應疾病變化及增強信念，肯定自我存在價值，降低對疾病產生的無力感，並使用藥物與其他技巧控制來緩解疼痛，期望藉此照護經驗分享，提供護理人員於臨床上照護類似個案能及早協助面對疾病引發相關心理層面問題之照護參考。

"This article described the experience of caring a patient with terminal nasopharyngeal cancer who experienced sudden death secondary to acute myocardial infarction when admitted for chemotherapy treatment. The patient was then transferred to the intensive care unit (ICU) for further care of cardiogenic shock. Death anxiety was precipitated because of his life-threatening condition and previous experience of death. The nursing care period was from March 10 to 16, 2016. A structured nursing care was performed following Roy's adaptation model. Information were collected from direct observation, physical assessment, and conversation. The main health problems included reduced cardiac output, acute pain, and death anxiety. The patient were instructed the following strategies: to openly express stress and feelings, to improve understanding of disease through readings, to adapt to heath conditions, and to enforce belief to reduce the sense of powerlessness. Medications and other skills for pain control were also provided. This report shares the experience of helping patients face the psychological aspects of a disease."