照顧一位乳癌末期合併腫瘤蕈狀傷口病人的安寧療護經驗

Nursing Experience for an End-Stage Breast Cancer Hospice Patient with Fungating Wound

張星玥(Hsing-Yueh Chang) ； 羅雅芬(Ya-Fen Lo) ； 潘雪幸(Hsueh-Hsing Pan)

《腫瘤護理雜誌》 14卷2期 (2014/12) Pp. 79-92

https://doi.org/10.3966/168395442014121402008

摘要

本文旨在探討一位乳癌末期合併腫瘤蕈狀傷口病人接受安寧療護之經驗。個案因乳癌蕈狀傷口疼痛、外觀改變及傷口異味所苦，且家屬面對個案病情惡化、即將往生產生預期性哀傷，故引發筆者探討之動機。護理期間自2012年10月5日至2012年10月20日，運用Gordon十一項健康功能型態評估以觀察、會談、身體評估等方式收集資料，確認個案有慢性疼痛、身體心像紊亂、家屬預期性哀傷等健康問題。護理過程運用安寧療護理念，了解個案疼痛情形、與醫師討論調整止痛用藥、教導個案疼痛控制技巧，輔以芳香精油、音樂治療等方式減輕疼痛；提供個別性的腫瘤蕈狀傷口照護，減少滲出液、出血，藉由薰燈或直接在傷口外層敷料滴上芳香精油，有效改善傷口異味，運用各項技巧來協助個案面對身體心像改變所造成之困擾；藉由主動陪伴、關懷、鼓勵個案及家屬適當的表達情緒，緩和家屬預期性哀傷，達到平安善終。經此個案報告，發現醫護人員對於腫瘤蕈狀傷口的照護知識了解相當有限，故建議院方能舉辦腫瘤蕈狀傷口照護之在職教育課程，或者建議專責的腫瘤蕈狀傷口照護護理師，以期提供更完善的照護品質。藉此個案護理經驗作為分享，提供照顧此類個案之參考。

關鍵字

乳癌 ； 蕈狀傷口 ； 安寧療護

並列摘要

This article describes the hospice care experience for an end-stage breast cancer patient with fungating wound caused by tumor. The patient suffered from chronic pain, body image disturbance, and wound odor from the fungating wound. Her family were in grief for her disease progression and approaching decease. Data were collected using the Gordon's 11 Functional Health Patterns through observation, interview, and physical assessment from October 5th, 2012 to October 20th, 2012. The health problems identified includes chronic pain, body image disturbance, and anticipatory grief. We recommended the physician to adjust pain medication according to the pain level. We taught the patient on pain control and used aromatic oils and music therapy to alleviate pain. We implemented special fungating wound care to reduce the odor, discharge, and bleeding as well as body image disturbance. Through the proactive companionship and caring, we encouraged the patient and her family to express their feelings to one another to ease anticipatory grief and hopefully to reach a peaceful death. Through this case, we learned that knowledge about nursing care of fungating wound is quite limited. We suggested nursing education to include courses of fungating wound care or hire nurse practitioners experienced in such care in order to provide higher quality of hospice care. This article can be used as a reference for future care of similar condition.

並列關鍵字

breast cancer ； fungating wound ； hospice care