照護一位首次診斷肺癌末期病人之加護經驗

Experience of Providing Intensive care to a Patient with a First-time Diagnosis of Terminal lung Cancer

本文敘述照護一位56歲個案，因呼吸困難就醫，初診斷為肺炎，又因頸部異常腫大做病理切片，進而診斷為肺癌末期之加護護理經驗。護理期間2021年9月20日至2021年10月11日，運用Gordon十一項功能性健康型態評估，藉由會談、觀察、身體評估方式收集資料，評估確立個案有多項健康問題，考量篇幅依照護需求的優先順序，故僅針對「低效性呼吸型態」、「營養狀態改變：少於身體需要」及「焦慮」三項健康問題進行探討。護理過程中，透過教導呼吸肌訓練，增強呼吸肌耐力，並提供胸腔物理治療及教導有效咳嗽技巧，改善呼吸問題；與營養師共同擬定營養照護計畫，並提供適度腹部按摩，促進腸胃蠕動，改善腸胃道營養吸收問題，增加營養攝取；傾聽情緒抒發且運用同理心，鼓勵個案面對心中的不安，主動向個案說明治療計畫，透過全人跨領域團隊會議，讓個案共同參與討論治療方針，並提供音樂治療、教導芳香療法及按摩技巧措施，緩解焦慮情緒。建議未來能在維護病人隱私的前提下，增設網路視訊裝置，藉此增加有效溝通不受新冠狀病毒疫情、距離等無法預期的限制，亦能夠減輕病人焦慮，提升照護品質。

The present paper describes the experience of providing intensive nursing care to a 56-year-old patient who sought medical attention for dyspnea. He was initially diagnosed with pneumonia, but a subsequent diagnosis of terminal lung cancer was made based on a pathological examination of abnormal neck swelling. Nursing care was provided from September 20 to October 11, 2021. The patient was assessed using Gordon's Eleven Functional Health Patterns, with data collected through conversations, observations, and physical assessments. Results of the assessment confirmed the presence of multiple health problems in the patient. In view of the length constraint of this paper and order of priority of nursing care needs, we only investigated the top three health problems of the patient, namely ineffective breathing pattern, deficient nutritional status, and anxiety. During the nursing care process, respiratory muscle training methods were taught to enhance respiratory muscle endurance. Chest physiotherapy and training on effective coughing techniques were provided to improve breathing problems. A nutrition care plan was formulated in collaboration with a dietitian, and a moderate abdominal massage was provided to promote gastrointestinal motility, improve nutrient absorption in the gastrointestinal tract, and increase nutrient intake. Emotions expressed by the patient were listened to and empathized with, and the patient was encouraged to face his feelings of unease. Besides receiving an explanation of the treatment plan, the patient was also allowed to participate in discussions regarding the treatment approach through holistic cross-disciplinary team meetings. Music therapy and guidance on aromatherapy and massage techniques were provided to alleviate the patient’s feelings of anxiety. Under the premise that patient privacy has been provided, the use of video conferencing in future nursing care is recommended to enable effective communication without being affected by unexpected limitations, such as the coronavirus disease 2019 pandemic, and distance. This also contributes to the alleviation of patient anxiety and improvement of quality of care.