照護一位乙狀結腸癌併肝轉移病患手術後之護理經驗

Experience of Nurses in Providing PostoPerative Care to a Patient with Sigmoid Colon Cancer and Liver Metastasis: a Case Report

本文是探討一位乙狀結腸癌併肝轉移的年輕病患，經確診後接受化學治療，使腫瘤縮小後接受手術的護理經驗。照護期間自2018年02月27日至03月13日，筆者運用Gordon十一項健康功能型態作為評估工具，藉由直接照護、觀察、治療性會談及身體評估等方式進行資料收集與分析，發現個案有四項護理健康問題：「現存性感染」、「急性疼痛／與手術後傷口有關」、「焦慮／與對疾病不確定感有關」、「身體心像改變／與癌症術後有關」等問題，依其問題擬定護理計畫及目標，教導個案疼痛控制方法、提升自我照護能力、攝取足夠營養以及傷口照護，進而改善傷口疼痛、感染、增加身體舒適度及緩解焦慮。建議臨床護理人員護理癌症患者，需認知每一個患者的獨特性，除了解決生理問題，更要深入了解心靈層面問題，以達全人醫療目標。

This article describes the experience of nurses in caring for a young patient with sigmoid colon cancer and liver metastasis who received chemotherapy after diagnosis and agreed to undergo surgery for reducing the tumor size. During the care period from February 27 to March 13, 2018, the Gordon's eleven functional help pattern was used for assessment. The author collected and analyzed the data using direct caring, observation, therapeutic talking, and physical evaluation. The following problems in nursing caring were identified: existing infection, acute pain, anxiety, and body image disturbance. Based on nursing issues and developing care plans and goals, nurses need to be taught about casebased pain management methods, improve self-care in patients, and describe adequate nutrition and wound care, which can help the patient in reducing wound pain and infection, increasing body comfort, and relieving anxiety. It is recommended that clinical nursing staff must provide adequate care to recognize the uniqueness of each patient. Besides solving physiological problems, it is also necessary to further understand the patient's psychological problems to achieve the goal of holistic medical treatment.