一位經歷病程迅速惡化之口腔癌患者的護理經驗

The Nursing Experience of a Rapidly Deteriorating Oral Cancer Patient

許欣卉(Shin-Hui Hsu) ； 孫美華(Mei-Hua Sun) ； 許夢萍(Meng-Ping Shu) ； 周繡玲(Hsiu-Ling Chou)

《腫瘤護理雜誌》 9卷1期 (2009/06) Pp. 73-86

https://doi.org/10.6880/TJON.200906_9(1).07

摘要

本篇報告在探討一位47歲原住民初次診斷口腔癌患者，經手術治療後腫瘤傷口仍持續惡化、潰瘍而入院，因腫瘤傷口產生嚴重疼痛，換藥時出血頻繁，又因腫瘤擴大及頸部淋巴回流受阻，導致頭頸部腫脹不適，所引發個案身、心、社會等問題。筆者於2008年2月10日至3月26日護理期間，藉由訪談、觀察並運用Gordon十一項健康功能型態進行評估，確立個案護理問題為口腔黏膜障礙、慢性疼痛、身體心像紊亂、預期性哀傷，藉由提供口腔清潔照護、腫瘤傷口護理及疼痛緩解技巧、及正向面對身體心像紊亂的事實、並協同安寧、社工共同合作，陪同個案及其家屬面對疾病病程進展，同時運用團隊合作方式安排心願完成，讓病人及家人生死兩無憾的走完人生，以達善終之目的。期望藉由此篇個案報告之護理經驗提供護理人員照護此類病人之參考。

關鍵字

口腔癌 ； 口腔黏膜障礙 ； 慢性疼痛 ； 身體心像紊亂 ； 預期性哀傷

並列摘要

This article is to describe a 47-year-old aboriginal in exploring the initial diagnosis of oral cancer patient. After surgery, the malignant fungating wound kept on deteriorating with ulcers which had caused hospitalization. The malignant fungating wound caused severe pain, bleeding frequently while dressing, which also compounded by the tumor expansion and neck lymphatic obstruction, resulted head and neck swelling and discomfort. It triggered body, mind, social and other issues in this case. From February 10, 2008 to March 26, 2008, the author collected data from interviews, observations and Gordon 11 functional health patterns for assessment, which established impaired oral mucous membrane, chronic pain, disturbed body image and anticipatory grief as the nursing problems. Providing oral hygiene care, fungating wound care, pain relief techniques, learn to face body image disturbance with positive thoughts, and collaborating with hospice and social workers facing the course of disease in progress. In the meantime, accomplishing the patient’s wish through team works, so patient and their families has no regrets walking through life for the purpose of hospice. Wish this case report can provide nursing experience as a reference for nurses who care for this kind of patients.

並列關鍵字

oral cancer ； impaired oral mucous membrane ； chronic pain ； disturbed body image ； anticipatory grieving