照護一位鼻咽癌病人併頸動脈爆裂症候群之急診護理經驗

Emergency Nursing Experience in Caring for a Patient with Nasopharyngeal Carcinoma Complicated by Carotid Artery Rupture Syndrome

本文描述經歷放射線治療後的鼻咽癌病人突大量鼻部出血，右側遠端頸內動脈爆裂而進行裝置緊急血管內支架動脈血管栓塞治療術（transcatheter arterial embolization；TAE）之護理經驗，護理期間為2022年11月12日至11月14日，筆者與病人建立治療性關係，護理過程中，運用「Gordon十一項健康功能型態」評估工具，觀察、會談、身體評估、直接照護、查閱病歷等方式收集主、客觀資料，經評估後護理問題有「組織灌流改變」、「急性疼痛」、「焦慮」。此病人因放射線治療後頸動脈周邊的血流缺血導致血管破裂所造成組織灌流改變，藉由TAE進行止血、適當補充靜脈輸液及輸血並持續觀察出血；急性疼痛方面，應用舒適技巧、主動關心及適當止痛以減緩疼痛產生；協助病人面對鼻咽癌頸動脈爆裂症候群造成生命威脅、疾病預後不確定感帶來的焦慮，適時給予關懷陪伴，提供身體照顧、心理調適以及個別護理措施，建議醫院將此措施製成醫病共享決策（Shared Decision Making，SDM）協助病人進行醫療決策以減少病人焦慮，給予心理支持，提升求生意志，重新肯定自我。筆者期望藉由此類須快速進行醫療決策又同時要兼顧身、心、靈照顧的護理經驗分享，提供臨床護理人員作為參考。

This article describes the nursing experience of a patient with nasopharyngeal carcinoma who experienced massive nasal bleeding following radiation therapy, leading to rupture of the right distal internal carotid artery necessitating urgent transcatheter arterial embolization (TAE). The nursing care took place from November 12th to November 14th, 2022. The author established a therapeutic relationship with the patient and utilized Gordon's Functional Health Patterns assessment tool to collect subjective and objective data through observation, interviews, physical assessments, direct care, and medical record review. Nursing diagnoses identified included ''alteration in tissue perfusion,'' ''acute pain,'' and ''anxiety.'' The patient experienced changes in tissue perfusion due to ischemia resulting from decreased blood flow around the neck arteries after radiation therapy, leading to vessel rupture. Nursing interventions included hemostasis through TAE, appropriate intravenous fluid and blood transfusion, and continuous monitoring of bleeding. To address acute pain, comfort techniques, active listening, and appropriate pain relief measures were employed. Assistance was provided to the patient in facing the life-threatening complications of nasopharyngeal carcinoma-related carotid artery rupture, uncertainty regarding disease prognosis, and resultant anxiety, through supportive care, physical and psychological adjustment, and individualized nursing interventions. It is recommended that hospitals develop Shared Decision Making (SDM) protocols to assist patients in medical decision-making, reducing anxiety, providing psychological support, enhancing will to survive, and reaffirming self-worth. The author aims to share this nursing experience, which involves rapid medical decision-making while considering holistic care, to serve as a reference for clinical nursing staff.