協助一位乳癌合併惡性傷口婦女身體心象紊亂的護理經驗

Nursing Care Experience of a Female Patient With Breast Cancer Combined Malignant Wound and Body Image Disturbance

林惠嫻(Hui-Xian Lin) ； 梁天麗(Tien-Li Liang)

《弘光學報》 53期 (2008/08) Pp. 67-81

https://doi.org/10.6615/HAR.200808.53.06

摘要

惡性傷口是一種複雜且難以癒合的傷口，對癌症病患而言是個極大困擾的症狀。本文旨在探討一位42歲女性患者因乳癌合併腫瘤潰瘍性傷口住院治療所引發的一連串身心反應的過程。護理期間自96年7月2日至96年7月28日止。筆者運用系統性的觀察、理學檢查、會談技巧、病歷資料收集並依據全人模式為概念架構進行主、客觀資料之收集，分析歸納後確立個案有疼痛、無效性保護能力、組織完整性受損、噁心感、焦慮、身體心像紊亂等護理問題。在生理層面部分、筆者提供傷口照護技巧以維持個案潰瘍傷口的乾淨舒適，減除惡臭及減少滲液，執行嚴格感染預防措施避免個案因白血球低下期間產生的伺機性感染；在心理層面，以主動關懷、同理心照護技巧，修正個案對自我的看法，改善其自我照顧能力並降低治療副作用帶來的焦慮感。個案最後因傷口受控制、異味降低、接受自己外觀改變並能運用資源以提升自我概念，於病情穩定之下由家屬陪同出院。癌症合併惡性傷口導致病患不僅必須面對疼痛出血的問題，往往也因外觀改變及異味等窘境而自我封閉，筆者將此特別的照護經驗提出與大家分享，並提供日後照護此類病患之參考。

關鍵字

乳癌 ； 惡性傷口 ； 身體心像紊亂

並列摘要

Malignant wound is a complex and un-healable wound. It strongly impacts on patient and causes a lot of distress. This article discusses an experience of nursing care to a 42 years old female patient suffering from breast cancer combined with malignant wound. She was admitted for advance treatment including mastectomy, wound debridement and chemotherapy. Patient’s data were collected through observation, physical assessment interview, and medical history. The patient's health problems identified include pain, ineffective protection, impaired tissue integrity, anxiety and disturbed body image. The author provided the appropriate wound care techniques and decreased the malodor and exudates of the wound. In addition, to establish the trust relationship, using caring, empathy skills and revise viewpoint of herself to enhance the skills of self care and to reduce the anxiety from chemotherapy. However, the patient regained positive self concept as well as physical and socio-psychological adaptabilities. Malignant wound treatment is getting noticed gradually. This kind of wound often goes with exudates, bleeding, pain, and unpleasant odor. The author is glad to share this successful experience with others in the nursing profession.

並列關鍵字

breast cancer ； malignant wound ； body image disturbance

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