照顧一位會陰癌合併惡性腫瘤蕈狀傷口病患之護理經驗

The Nursing Experience of a Vulvar Cancer Patient with Fungating Wound

李存白(Shun-Pai Lee) ； 蔣曉文(Hsiao-Wen Chiang) ； 張靜安(Jing-An Chang)

《腫瘤護理雜誌》 6卷1期 (2006/06) Pp. 43-54

https://doi.org/10.6880/TJON.200606_6(1).05

摘要

隨著緩和醫療的被重視，惡性腫瘤蕈狀傷口的處理也漸漸的受到注意，主要是因惡性腫瘤蕈狀傷口經常會出現滲液、出血、疼痛及令人不悅的氣味，而使病人發生身體心像紊亂、親密感受阻及社交障礙之健康問題，造成病人難以言喻的苦痛，進而降低病人生活品質。本文係探討一位會陰癌併發惡性腫瘤蕈狀傷口個案的護理經驗，個案因傷口滲液、惡臭、疼痛、皮膚完整性受損等症狀入院，護理人員藉由觀察、會談、身體評估、疼痛評估，及運用Gordon十一項健康功能性評估，確立個案護理問題有：1.現存性感染，2.疼痛，3.知識缺失，4.身體心像紊亂等4項問題。護理過程中，筆者採用安寧療護理念，不斷的給予個案及家屬誠懇之關懷、接納、支持與鼓勵，建立其對醫護人員的信任與配合，並依個案傷口的狀況，選擇適合的敷料，給予傷口清潔護理，同時解決個案及家屬傷口照護之困難，以改善傷口的惡臭及滲液，增加個案的自我照顧能力及家屬的照顧技巧，而減輕個案因傷口所產生的困窘或羞恥之感覺，進而評估個案與家屬的出院準備需求，協調居家照護資源，使個案順利出院返家，接受居家安寧照護，獲得身、心、靈的滿足。

關鍵字

惡性腫瘤蕈狀傷口 ； 會陰癌 ； 安寧療護

並列摘要

As palliative medicine is emphasized nowadays, malignant fungating wound treatment is getting noticed gradually. This kind of wound often goes with exudates, bleeding, pain, and unpleasant odor. Therefore, it strongly impacts on patients, brings a lot of distress, and causes the problems of disturbed body image, interrupted intimate feeling and impaired social activity. Then the patient's life quality was lowered. The case study is to explore the nursing experience of vulvar cancer patient with malignant fungating wound. The patient was admitted to the hospital due to the exudates, malodor, pain, and impaired skin integrity of the wound. The authors used Gordon's eleven functional health patterns as a guide to identify and assess the patient problems. Data were collected through observation, interview, physical assessment, and pain assessment. The patient's problems found were: high risk for infection, pain, deficit knowledge, and disturbed body image. To establish the trust relationship, the authors applied the concept of hospice care to nursing care, and provided caring, acceptance, support, and encouragement to the patient and her family during the nursing process. Then the authors chose the appropriate dressing, cleaned and cared for the wound according to the wound condition to solve the family's difficulties in wound care and improved the malodor and exudates of the wound. In addition, the patient's self-care ability and the family's caregiving skills were enhanced. The patient's embarrassment and shame of feelings due to the wound were reduced. The authors further assessed the patient's and family's needs of discharge planning, and coordinated the resources of home care. Finally the patient could be discharged and smoothly go home, received hospice home care, and achieved the physical, psychological, and spiritual satisfaction.

並列關鍵字

malignant fungating wound ； vulvar cancer ； hospice care