一位轉移性子宮內膜癌自殺病人之重症照護經驗

Nursing Experience of a Suicide Patient with Metastatic Endometrial Cancer in the Intensive Care Unit

本文為照護一位61歲女性子宮內膜癌併肺轉移個案，服用固殺草自殺之重症護理經驗。照護期間為2018年10月14日至2018年11月4日，利用觀察、身體評估及與家屬會談等方式，運用整體性護理評估，確立病人有心肺組織灌流失效、口腔黏膜受損、家屬預期性哀傷等健康問題。護理期間因氣管內管放置，運用組合式照護模式，預防病人產生呼吸器相關肺炎。運用低壓力口腔抽吸，及自製紗布壓舌板，吸附口腔內血水，減少口腔黏膜傷害進而改善口腔多處潰瘍。照護過程透過家庭共同會議，和家屬討論安寧緩和療護及死亡議題，聆聽家屬的想法，協助家屬共同醫療決策，陪伴病人及家屬度過生命末期照護過程。

This paper described the nursing experience of caring a 61-year-old female with endometrial cancer and having lung metastases, committed suicide by taking the glufosinate herbicide. The duration of care was from October 14 to November 4, 2018. Data was collected by observation, physical assessment, talk with family, and chart review. The patient's health problems were identified, including ineffective tissue perfusion / lung, oral mucosa injury, and anticipation of grief by conducting holistic assessment. Due to endotracheal tube placement during care, we used bundle care to prevent patient from induced ventilator-associated pneumonia. The use of low-pressure oral suction and homemade gauze tongue depressor absorbed blood in the oral cavity, reduced oral mucosal injury, and improved multiple oral ulcers. Through the family meeting, the care team discussed the issues of tranquility, relief, and death with the family, listens to the family's ideas, assisted the family making medical decision, and accompanied the patient and family through the end-of-life care process.