照顧一位乳癌婦女惡性蕈狀傷口之照護經驗

本篇是描述照顧一位乳癌惡性蕈狀傷口個案，在發現乳房腫塊時，因初期的未重視，而延誤適當治療時機，經由適切的護理措施及住院接受治療過程之照護經驗。照護期間自103/2/21-103/2/28，藉由會談、觀察、檢閱蒐集資料，將內容統整分析，以Gordon十一項健康功能性評估，確立個案有慢性疼痛、組織完整性受損、焦慮等健康護理問題。針對個案提供個別性護理計劃，提供有效的止痛藥物及非藥物治療照護；善用衛教方式提供正確疼痛控制觀念，減輕個案疼痛不適，採持續性及主動關懷的態度陪伴個案，與個案建立良好的信任關係，並以同理心陪伴個案面對疾病，緩解焦慮，使個案重新肯定自己存在的價值與意義；提供疾病照護相關的資源與資訊，讓個案得到個別性的整體照護，協助改善生活品質及促進傷口舒適，成功讓個案順利出院回家。筆者期望藉由本文之護理經驗，提供臨床同仁照護類似個案的參考，以提升病人的照護品質及生活品質。

關鍵字

乳癌；惡性蕈狀傷口；傷口照護；疼痛

並列摘要

This article describes the one-week care experience of a breast cancer patient who delayed her treatment of a breast lesion due to her ignorance. Data was collected and interpretation made through interview, observation and inspection. Gordon's eleven functional evaluations showed that the patient's problems were anxiety, chronic pain and tissue defect. An individualized care plan addressed reduction of anxiety, pain control and tissue healing. Interventions included: 1) establishment of rapport, consistent care, and empathetic companionship to help the patient accept her diagnosis, 2) patient education on proper pain management and effective use of both narcotic agents and non-pharmacological measures, and 3) proper wound management. The patient received individualized care and resources for continued care. The patient was able to renew her own value, show positive attitude toward her condition, and was discharged with improved comfort, wound healing and quality of life.

並列關鍵字

breast cancer ； fungating wound ； wound management ； pain

參考文獻

莊玟玲、謝岫庭（2009）．一位惡性蕈狀傷口合併腸皮瘻管個案之護理經驗．護理雜誌，56（1），91-95。doi:10.6224/JN.56.1.91

Probst, S., Arber., A, & Faithfull, S. (2013). Malig-nant fungating wounds: The meaning of living in an unbounded body. European Journal of Oncology Nursing, 17(1), 38-45. doi:10.1016/j.ejon.2012.02.001

Albi-Feldzer, A., Mouret-Fourme, E. E., Hamouda, S., Motamed, C., Dubois, P. Y., Jouanneau, L., & Jayr, C. (2013). A double-blind randomized trial of wound and intercostal space infiltra-tion with ropivacaine during breast cancer surgery: effects on chronic postoperative pain. Anesthesiology, 118(2), 318-326. doi:10.1097/ALN.0b013e31827d88d8

行政院衛生署（2012）．101年度死因統計．2013年3月10日取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=1717