การพยาบาลผู้ป่วย Superior Vena Cava Syndrome: รายงานกรณีศึกษา

Abstract

Objective: To study the theoretical knowledge comparing to the case study in order to develop appropriate nursing care for patients with Superior Vena Cava Syndrome.

Case Presentation: Superior Vena Cava Syndrome (SVCS) is a clinical syndrome of facial, neck, upper thorax and upper extremities swelling, usually due to severe stenosis or occlusion of SVC. The most common cause of SVCS is malignant disease. Case study; A 53-year-old Thai male with neck and facial swelling. Dyspnea on exertion, no underlying disease, heavy smoking. The physical examination; Good conscious. Edema of the face, neck, upper thorax. Dilated veins of neck and chest wall. Lung: rhonchi both lung, normal movement. CXR: mass at right paratracheal region with mass effect on the right pulmonary, pleural and pericardial effusion. CT chest: suspicious of primary lung cancer. The diagnosis of this case was superior vena cava syndrome. Nursing care, recognition of early signs of SVCS can allow treatment before life threatening symptoms of respiratory and neurologic distress occur. Nursing assessment includes strict moritoring of vital signs, level of conscious, edema, tissue perfusion, respiratory status. Fluids and electrolyte balance should be monitored because overhydration may exacerbate of symptom of SVCS. Nursing interventions in patient with SVCS included measures to relieve dyspnea. Such as elevating the head of the bed and providing oxygen. Prescribe dexamethasone to prevent the acute respiratory obstruction. Nurses should assess patient and family for ineffective coping, depression, and anxiety, and provide interventions to improve coping abilities.

Conclusion: SVC syndrome is a clinical emergency, which are leading to high morbidity and mortality, if the diagnosis, treatment and nursing care are delayed. Therefore, medical concern of this condition is vitally important including early appropriate treatment and nursing care.