- 期刊
照顧一位口腔癌末期合併右頰腫瘤蕈狀傷口個案之照護經驗
Providing Nursing Care for a Patient with End Stage Oral Cancer Combined with Fungating Wounds of the Right Cheek
摘要
本文描述一位40歲男性，罹患口腔癌末期合併右頰蕈狀傷口之照護經驗。因疾病復發合併開放性蕈狀傷口，導致傷口出血、惡臭及疼痛，亦因疾病惡化不可逆，面對接近死亡的事實和將與家人分離所產生的失落情緒，使個案身心飽受衝擊，進而引發筆者探討之動機。照護期間自2018年10月21日至2018年11月15日，透過身體評估、會談、觀察等方式，並運用Gordon十一項功能性健康型態評估個案身、心、社會、靈性等層面的健康問題，確立問題為「組織完整性受損」、「慢性疼痛」、「哀傷」，依個案護理問題提供個別性及整體性護理措施，針對傷口狀況透過選擇合適敷料及芳香療法，改善傷口滲液及異味；透過與醫療團隊討論用藥及輔助療法如：肌肉按摩、轉移注意力等，有效緩解疼痛；於個案面對死亡迫近及與家人即將分離產生失落哀傷情緒時，透過生命回顧、傾聽陪伴及醫療團隊合作，協助個案及家屬以正向的情緒度過哀傷，並於完成道謝、道歉、道愛、道別的過程裡找到生命價值及意義。建議錄製蕈狀傷口照護影音資料；鼓勵護理人員精進腫瘤傷口照護新知；教育訓練增設居家安寧療護相關課程。期望藉此護理經驗提供參酌，使護理人員於照護此類癌末病患時能夠適時提供護理計畫及衛教指導，以提供完善照護品質。
並列摘要
This article describes the nursing care for a 40-year-old male patient with end stage of oral cancer and fungating wounds on the right cheek. Because of the recurrence of the disease combined with the open fungating wounds, the wounds were bleeding with door and pain. The irreversible exacerbation of the wounds leading to the inevitable death and farewell to friends and family also caused depression in the patient. All of the above have inspired this discussion in the author. During the nursing period from October 21st, 2018 to November 15, 2018, physical examinations, interviews, observations, and the Gordon's eleven Functional Health Patterns were used to assess the health problems of the patients from the physical, social and spiritual point. The identified problems were ＂the damaged integrity of the tissue＂, ＂chronic pain＂, and ＂sadness＂. The customized care and integrated nursing process were provided too address all the health issues of the patient. Through proper wound care with proper dressing and aromatherapy, the odor and exudate was reduced. With the proper medication from the medical team and the adjuvant therapy such as massage and attention diversion techniques, the pain was alleviated. In the face of death and the eventual final good-byes to the family, we assisted the patient and the family to overcome the sadness with positive attitude by sharing their life's stories and memories, listening to one another, and just being present for the patient. The team helped them to find value and meaning of life through the phases of appreciation, apologies, love and farewell. It is recommended to record the fungating wounds caring process and to encourage the nursing staff to advance the knowledge in wound care of the neoplasm. The education training should also include the courses about in-home palliative medicine. We hope that the nursing experience for this patient with end stage cancer will serve as a plan and education for nursing staff to provide comprehensive quality nursing care.
參考文獻
延伸閱讀
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