一位初次診斷食道癌第四期患者之護理經驗

Nursing experience of a patient diagnosed with stage IV esophageal cancer for the first time

本篇敘述一位51歲男性在沒有心理預期下初次診斷食道癌之護理經驗，患者因對疾病治療的不了解、死亡的威脅和擔心家人後續生活等而產生生理及心理問題，引發筆者探討之動機。筆者自2019年3月21日至2019年4月4日護理期間，藉由查閱病歷、身體評估、觀察和會談等方式進行Gorden十一項健康功能型態評估，確立個案有營養狀況改變：少於身體需要、焦慮和個人因應能力失調。照護期間主動關心、陪伴個案，建立互信的治療性關係，以穴位按壓減緩噁心、嘔吐的症狀，共同討論擔憂的問題並設法解決，以減輕焦慮，經由錄製灌食、傷口換藥影片和製作簡易空腸造瘻模型，讓個案和家屬了解空腸造瘻照顧的知識，反覆練習操作模型，使個案照顧技巧更熟練，進而改善營養問題，使用腹膜透析管路固定腰帶來收納空腸造瘻管，增加患者舒適和提升生活品質。建議可建置衛教影片，製作或購置空腸造瘻模型以提供患者及家屬練習。期望藉由此次護理經驗分享，能作為日後照護此類患者之參考。

This article describes a 51-year-old man who first diagnosed of esophageal cancer without psychological expectations. The patient's physical and psychological problems due to the lack of understanding of the disease treatment, the threat of death, and the worry of the family's subsequent life, etc., led to the author's motivation for writing. From March 21, 2019 to April 4, 2019, the author conducted Gorden's 11 health function assessments by reviewing medical records, physical assessments, observations, and interviews. The cases were established changes in nutritional status: less than the need of the body, anxiety, and personal coping dysfunction. Active care and accompanying cases during care, establish a therapeutic relationship of mutual trust, use acupressure to slow down the symptoms of nausea and vomiting, discuss concerns and solve problems to alleviate anxiety, record the feeding, wound dressing films and make simple the jejunostomy model allows the case and family members to understand the knowledge of jejunostomy care, and repeatedly practice the operation model to make the case care skills more proficient, thus improving the nutritional problems. The peritoneal dialysis tubing is used to fix the waist to accommodate the jejunostomy tube to increase patient comfort and improve the quality of life. It is recommended that health education videos can be made, and jejunostomy models can be made or purchased to provide exercises for patients and their families. We hope to share this nursing experience, can be used as a reference for future care of such patients.