一位胰臟癌合併空腸造口術後病人之護理經驗

Nursing Experience Caring for a Patient with Pancreatic Cancer and Jejunostomy

依據衛生福利部2018年統計，十大死因仍以惡性腫瘤續居首位，胰臟癌位列第八順位，由於胰臟癌診斷不易，故發現時大多已為局部晚期或是轉移，本篇個案報告為探討一位66歲首次確診晚期胰臟癌之女性病人，入院行惠普式手術及空腸造口留置之照護經驗，照護期間照護期間2019年10月1日至11月8日，筆者運用歐倫自我照顧理論進行評估，經由身體評估、會談、觀察、病歷查閱等方式蒐集資料並確立護理問題為急性疼痛、營養不均衡、身體心像紊亂，照顧期間以傾聽、陪伴、適時的指導並結合醫療團隊共同引導個案面對疾病及接納身體的改變，根據病人健康問題提供個別性照護並給予個案正向回饋，透過此次的照顧經驗，筆者體會到非預期性病程發展對癌症病人之身、心理壓力影響甚多，故希望能藉由本篇報告，提供護理人員在臨床上面對癌末病人治療期間的照護建議。

According to the statistics of the Ministry of Health and Welfare of Taiwan, the top ten causes of death are still ranked first by malignant neoplasms, among which pancreatic cancer occupies the eighth place. Because pancreatic cancer is extremely difficult to diagnose, most cases are locally advanced or metastatic upon discovery. This essay describes the nursing experience caring for a 66-year-old female patient with advanced pancreatic cancer, who underwent the Whipple operation and jejunostomy. The nursing period was from October 1 to November 8, 2019. The author followed Orem’s Self-Care Deficit Nursing Theory to evaluate the collected patient data. Acute pain, imbalanced nutrition, and disturbed body image were highlighted as the chief nursing problems. To address these concerns, the nursing care plan for the patient included guiding them to gradually accept the body image changes as a consequence of the disease, and individualized care was provided with cooperation from the medical team to address the patient’s health concerns. Through this nursing experience, the author came to realize that the unexpected manifestation and progression of cancer generated immense physical and psychological pressure for the patient. It is suggested that spiritual care for cancer patients should be included as part of on-the-job training to help improve the quality of care provided to terminal cancer patients.