於加護病房照護一位舌癌末期併多重轉移病患之經驗

Experience the Case of ICU Care at the End of a Terminal Tongue Cancer and Multiple Tumor Metastasis

本文旨在探討照護一位舌癌末期併多重轉移個案接受胸椎手術後於加護病房之護理過程，個案2011年11月診斷舌癌，2012年5月轉移肺部皆曾手術治療，此次因下肢無力、無法自解尿液求治，診斷第六到第八胸椎有腫瘤轉移，雖於術前已告知無法治癒，只能減輕脊椎壓迫症狀，但個案仍保持強烈求生意志，直至醫師宣告生命末期將至，其除了承受生理不適外，亦面臨臨終所帶來的心理衝擊與壓力過程。護理期間自2012年6月13日至7月8日。筆者藉由觀察、會談、身體評估等方式進行生、心、社會與靈性之整體性評估，發現個案主要護理問題有呼吸道清除功能失效、疼痛及無望感，在照護期間因呼吸費力及疼痛給予個別性護理措施，並藉由會談建立互信關係，鼓勵個案及家屬表達內心感受，並引導個案與家人道別，協助個案接受及面對生命末期。

This article discusses the treatment in intensive care after spinal surgery in a patient with a tongue cancer developing multiple tumor metastasis. The patient had surgeries both on Nov. 2011 and May. 2012 for tongue cancer and lung cancer, but this time due to lower limb weakness and inability to urinate, diagnosis of the sixth to eighth thoracic tumor metastasis confirmed no possibility of cure; only alleviation of the symptoms of spinal oppression before surgery. However even under such adverse conditions, the patient still maintained a strong will to live. In addition to the physical discomfort, the patient was confronted with psychological impact and pressure, until the doctor declared the end of life. Nursing from 2012 June 13 to July 8 by observation, interview, and physical assessment provided comprehensive evaluation on physiological, psychological, social and spiritual dimensions. The patient's primary care problems were related to ineffective airway clearance, pain and hopelessness. Individual nursing was given when respiratory effort during care and pain caused by diseases was too much to bear, also the case required interview to establish a relationship of trust by encouraging the patient and family members to express feelings, and to guide the patient to say goodbye to their family members, and to help the patient accept and face the end of life.