照顧一位下背部類肉惡性腫瘤合併蕈狀傷口病人的護理經驗

本文敘述一位罹患下背部類肉惡性腫瘤病人的照護經驗，個案因惡性腫瘤蕈狀傷口疼痛、大量分泌物、惡臭、出血等症狀所困擾，且家屬面對個案生命即將終了產生哀傷情緒，筆者於2014年5月16日到6月4日之護理期間，透過臨床觀察、直接照護及與病人、家屬的互動、會談等方式蒐集資料，運用系統性評估病人身、心、靈、社會的全人需求，確認有慢性疼痛、皮膚完整性受損、預期性哀傷等健康問題。護理過程介入疼痛緩解技巧、腫瘤傷口護理（TIME原則）及與安寧共照團隊的全隊合作，陪同全家面對疾病的進展，全程陪伴到最後善終的目的。本院位處離島地區醫院，較少接觸腫瘤蕈狀傷口個案，對相關照護知識有限，故照護初期之傷口照護及面對病人、家屬的負面情緒對護理人員造成些許壓力，期望透過此個案報告經驗分享提供日後照護此類病人參考。

關鍵字

惡性腫瘤；腫瘤蕈狀傷口；傷口照護

並列摘要

This article describes a nursing care experience of a patient with lower back sarcomatoid carcinoma complicated with fungating wound. The patient suffered chronic pain, bleeding with copious secretions, unpleasant odor, and symptoms related to the fungating wound. His family exhibited grief due to his pending death. The 3 weeks care experience in 2014 used observation, review of patient records on physical, psychological, social, and spiritual, interviews and clinical care. Major health issues identified were chronic pain, impaired skin integrity and anticipatory grief. Nursing care activities provided included pain relief technique; tumor wound care (TIME principle), collaboration with hospice team and the family so they could accept the deterioration at end of life care. The Penghu Regional Hospital was not previously experienced with fungating wound. The author gained knowledge and skill through the process and the ability to manage family's negative emotions. This article may be used as a reference for future care of patients with similar conditions.