照顧一位血液透析多次腎癌復發青壯年病人之護理經驗

Nursing experience in caring for a hemodialysis young patient with multiple cancer recurrence

本文描述照顧一位長期血液透析的青壯年男性，因多次癌症復發加上標靶藥物治療下，出現多重副作用而面臨減藥及停藥困境，使個案擔憂癌症治療成效，及對未來生活的不可控制下，不斷出現負向談話引發筆者關注。護理期間自2021年01月04日至02月26日，筆者運用生理、心理、社會及靈性層面進行整體性評估，並透過觀察、病歷查閱、身體評估及會談收集資料，確立個案有「潛在危險性出血」、「腹瀉」及「無望感」之健康問題。筆者藉由個案血液透析治療期間，給予主動關懷，運用傾聽及肢體語言方式，增加個案信任感，並從中了解個案生活習慣；對疾病、未來生活的疑慮與不安感受，個別進行澄清並媒合醫療成員及病友團體等，以增強個案對疾病治療認知，尋找不一樣的生命意義；降低個案腹瀉及潛在危險性出血相關問題，以增進個案對疾病自我生活注意事項及生活掌控度。建議針對該類病人在門診追蹤時，可增加心理層面評估，透過專科醫師檢視下及早發現病人是否有情緒困擾問題。

 

This article describes the care of a young adult male long-term hemodialysis patient. The patient was concerned about the efficacy of cancer treatment due to multiple side effects after multiple cancer recurrences and target drug therapy, which resulted in dose reduction and drug discontinuation. In addition, the patient also had a problem of facing the uncontrollable future of life and his continuous pessimistic attitude attracted the author’s attention. From January 04 to February 26, 2021, the author conducted a comprehensive assessment of the physiological, psychological, social and spiritual aspects, and employed through observation, medical history review, physical evaluation and interview, to confirm that the patient had “potential risk of bleeding”, “diarrhea” and “sense of hopelessness”. During the period of hemodialysis, the author actively cared for the patient, used listening and body language to increase the trust of the patient, and learned the lifestyle habits of the patient, clarify the doubts and uneasiness about the disease and the future life of the patient and coordinated with medical team members and patient groups, to enhance the patient’s understanding of the treatment of the disease and search for the different meaning of life. This reduced diarrhea and potential bleeding-related problems, which enhanced the self-awareness and control of the disease by the patient. It is suggested that psychological assessment should be added to the outpatient follow-up, so as to promptly determine whether patients have emotional distress through specialist examination.