一位肝癌末期病人之加護護理經驗

The Nursing Experience of Caring a Patient with Terminal Hepatoma in the Intensive Care Unit

本文描述一位肝癌末期病人接受經動脈血管栓塞術治療後發生肝膿瘍引發敗血症之護理經驗，照護期間為2019年1月14日至2019年1月29日，透過觀察、筆談、會談、身體評估及病歷查詢等方式收集資料，運用Gordon十一項健康功能評估，確立個案健康問題包含「疼痛」、「低效性呼吸型態」及「預期性哀傷」。護理過程中主動關懷與病人建立良好的護病關係，提供個別性護理活動。藉由完整的疼痛評估、除止痛藥物控制外，提供非藥物止痛方法，期間案妻因不忍個案插管痛苦要求撤管，因個案肺部症狀改善，在團隊成員協助下成功讓個案脫離呼吸器，並有機會計畫未來，與妻子討論後簽立不施行心肺復甦術意願書，選擇未來疾病走到盡頭時之治療方式。積極協助個案向家人表達內心感受，並協助案妻抒發情緒及表達內心想法，共同生命回顧正向面對未來死亡之歷程。期望藉由此護理經驗分享提供護理人員照護重症癌症末期病患之參考。

This article described the nursing experience of caring a terminal hepatoma patient who suffered from liver abscess and septicemia after transcatheter arterial chemoembolization treatment. The author assessed the patient with Gordon's 11 functional health assessment tool, and collected the data through observation, conversation, nursing care, and chart review. The duration of nursing care was from January 14 to 29, 2019. The patient's problem included pain caused by abdominal tumor, ineffective breathing pattern, and anticipatory grief. The nursing team provided active care to establish a good relationship with the patient and create individual care activities. Cancer pain was assessed during nursing process and controlled by medications and non-medication pain relief methods. In response to the request to extubate from the patient’s wife, who could not stand the pain of intubation inflicted on the patient, the medical team helped the patient successfully come off the ventilator when his lung situations improved. The future of the patient was discussed, and the wife decided to sign the do not resuscitate (DNR) consent form and chose the treatment method for the patient when the disease completes its course. We hope the bereavement counseling of the family would continue and this nursing experience could provide a reference for caring terminally ill patients.