一位長期洗腎病人面臨肺癌接受標靶藥物治療之門診照護經驗

Outpatient Care of a Hemodialysis Patient Under Targeted Therapy for Lung Cancer

本文是探討一位69歲女性長期洗腎又面臨罹患肺癌接受標靶藥物治療，出現皮膚癢、紅疹、化膿且導致食慾不振，營養攝取不足，因而情緒低落，產生無望感之門診照護經驗。於2022年1月24日至2022年4月18日照護期間，運用Gordon十一項健康功能型態為評估工具，藉由門診照護、觀察、會談及電訪方式收集資料，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，故針對「皮膚完整性受損」、「營養狀態改變：少於身體需要」及「無望感」三項健康問題進行探討。護理過程中，提供標靶治療及副作用相關資訊，教導皮膚照護措施，改善皮膚問題；透過結合個管師及營養師跨團隊照護，利用食物圖卡及模型，衛教鼓勵少量多餐，教導促進食慾的方法，提升飲食認知，增加營養攝取，使個案獲得足夠營養；提供標靶藥物治療及照護相關資訊，教導因應技巧，克服藥物副作用產生的不適，並藉由病友間經驗分享，引導正向的態度面對治療，增加對治療的信心，進而改善無望感。建議在門診照顧過程中，可利用數位影片、團體衛教及衛教單張等採多元衛教方式，讓病人獲得疾病資訊，增強正確疾病照護知識及了解治療方向，提升照護品質。

This study discusses the outpatient care of a 69-year-old female patient on long-term kidney dialysis who also underwent targeted therapy for lung cancer. She experienced skin itching, rashes, and suppuration, which led to poor appetite, malnutrition, depression, and a sense of hopelessness. Gordon’s Eleven Functional Health Patterns were used as an assessment tool during her care period from January 24 to April 18, 2022. Multiple health issues were identified via outpatient care, observation, interviews, and phone calls. Owing to the length limitations and the need to prioritize care needs, this study focuses on three specific health problems:“Impaired skin integrity,”“Altered nutritional status: below body requirements,”and“Sense of hopelessness.”The care process included providing information about targeted therapy and its side effects, along with skin care measures to mitigate skin issues. An interdisciplinary team including case managers and dietitians used food cards and models to educate and encourage the patient to eat small, frequent meals. To improve her dietary awareness and increase nutritional intake, the patient was taught methods of stimulating her appetite to ensure that she received adequate nutrition. Information on targeted therapy care and coping skills was also provided to overcome the discomfort caused by drug side effects. Additionally, sharing experiences among patients promoted a positive attitude toward treatment, which increased her confidence in therapy and alleviated her sense of hopelessness. Various health educational approaches such as digital videos, group education, and educational leaflets should be used during outpatient care to provide disease information, enhance patients’understanding of disease care and management regimens, and improve the quality of care.