罕見臍尿管癌病人照顧與協助家屬醫療決策之案例報告

Caring for a Patient With Rare Urachal Carcinoma and Facilitating Family Medical Decision-Making: A Case Report

本案例為一28歲之男性，因腹部腫脹就醫，診斷轉移性臍尿管癌，此為罕見且高度侵襲性、預後差的惡性腫瘤。護理照護期間自2022年11月7日至2023年5月16日。本文個案住院第四日，因氣喘致呼吸困難併急性呼吸窘迫，接受緊急氣管插管，並轉入胸腔加護病房接受重症照護。在照護過程中，專科護理師發揮跨專科協調與整合能力，秉持「以病人為中心」的照護理念，跨科連繫團隊並運用「倫理四象限」為指引，介入家屬醫療決策議題。因病人意識受損，其病史與相關資訊由案母提供。主要呈現病人接受化學治療之自主醫療決策過程；經歷化學治療引發重度腫瘤溶解症候群及急性腎損傷併發症之處理；家屬間對化療意見衝突與安寧療護醫療抉擇之挑戰。醫療團隊發揮合作精神，共同完成個案病情多變而複雜的照護經驗，作為臨床護理照顧參考。

This case was a 28-year-old male patient newly diagnosed with metastatic urachal carcinoma who presented with abdominal distension. Metastatic urachal carcinoma is rare and highly aggressive and associated with poor prognosis. The care period was from November 7, 2022 to May 16, 2023. On hospital day four, the patient developed acute respiratory distress, which required endotracheal intubation and transfer to the intensive care unit. The nursing practitioner facilitated cross-coordination between oncology and critical care teams. The“Patient-Centered Care”concept and“Four Quadrants”ethical framework were applied to address dilemmas in medical decision-making. Clinical information was primarily obtained from the patient’s mother. This case highlights the challenges involved in respecting patient autonomy regarding chemotherapy, managing severe tumor lysis syndrome with acute kidney injury complications, and dealing with family conflicts regarding medical decision-making in end-of-life care. By coordinating across the healthcare team, we effectively managed a complicated and evolving clinical course. This case report was prepared to share our experience as a reference for clinical nursing practice.