一位肺結核中斷服藥併惡性腫瘤之個案管理經驗

Case Management of a Patient with Tuberculosis, Drug Noncompliance, and a Malignant Tumor

本文乃敘述照護一位肺結核個案，因工作因素須各地奔波，無法定期服藥及接受都治計畫，治療期間發現罹患惡性腫瘤，接受手術治療之護理經驗。個案於2008年8月通報肺結核，門診治療期間因工作及經濟因素曾多次中斷治療，至2009年7月診斷出十二指腸壺腹腫瘤住院治療。於2009年7月20日至8月14日照護期間，運用Or em自我照顧理論進行護理評估，確立個案有：無效性健康維護能力、營養少於身體所需、焦慮等健康問題。管理過程當中發現個案因失業經濟困窘，又不願接受他人協助，致有多次中斷服藥；發現罹患惡性腫瘤後，原本因經濟考量不願接受手術治療，經筆者多次勸說，真誠關懷並同理個案處境，取得個案的信任後，終於說服個案接受社會資源之協助，順利完成手術。出院後利用電訪與病患保持聯繫與良好護病關係，在筆者持續關懷下陪伴個案完成肺結核之藥物治療。期望透過本文的經驗分享，能在結核病個案的照護上，特別是經濟有困難的個案能有更好的護理措施，尋求完善的社會資源得以運用。

The article reports on nursing experience with a patient with tuberculosis (TB), medication noncompliance, and a malignant tumor. He could not take medicine regularly or accept DOTS (Directly Observed Treatment, Short-course), because he travelled for his job. The patient was diagnosed with TB in August, 2008, and received treatment in our outpatient department. The treatment was interrupted many times because of his job and economic factors. An Ampulla of Vater tumor was diagnosed in July, 2009, and he was admitted for surgery in our hospital. The period of nursing was from July 20 to August 14, 2009. Orem Self-care theory was used as the framework for patient assessment. The patient had ineffective health maintenance, poor nutrition, and anxiety as well as employment and economic problems, and was not willing to accept assistance, so that he interrupted his medication treatment. He had a malignant tumor, but did not want to accept surgery because of economic considerations. Through active care and sincere empathy, the author and the patient established a therapeutic relationship with mutual trust. The patient was convinced to accept the assistance of social services, and completed surgery. After the patient was discharged from the hospital, the author kept in contact with him and gave assistance in completing the course of medication for TB. Through this report, the author wishes to share this experience in order to promote the care of similar patients in the future, especially those people who have economic problems and need to seek social services.