一位癌症末期青少年併有惡性蕈狀傷口之安寧療護經驗

Nursing Care Experience of a Teenager with Malignant Fungating Wounds in the Cancer Terminal Stage

曾鳳芸(Feng-Yun Tseng) ； 胡麗敏(Li-Min Hu) ； 曾紀瑩(Chi-Ying Tseng)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 64-75

https://doi.org/10.6740/NTUHJN.201901_15(1).0007

摘要

本文主要係照顧一位罹患橫紋肌肉瘤十五歲男性青少年，因面對疾病末期不可逆的功能喪失、悲傷情緒和蕈狀傷口分泌物的惡臭和疼痛等問題，使個案在生理、心理、社會和靈性上造成極大衝擊，影響其生活品質之護理過程。於2016年6月17日至7月10日之照護期間，以緩和醫療全人照護為目標，運用觀察、會談及Gordon 11項評估工具，確立個案有身體心像改變、慢性疼痛、預期性哀傷等健康問題，藉由跨團隊合作模式，提供完整的評估與護理措施，促進個案之舒適，緩解其心中的無力感、孤單和哀傷；有效的傷口處置及改善外觀方式，使其能接受身體外觀之改變；與個案共同討論及選擇可接受的止痛方式等護理措施，讓個案做好面臨生命消逝之準備。希望藉由分享此成功之護理經驗，提供相關護理人員照護惡性蕈狀傷口和面對青少年癌症末期照護之參考。並建議其他相似單位，平時可提供青少年疾病末期照護病童分享和增加醫護人員情緒紓解空間，以促進相關護理人員可以提供更完整之護理照護品質。

關鍵字

安寧療護 ； 癌症末期 ； 青少年 ； 蕈狀傷口

並列摘要

This article described the nursing care experience of a teenager with Rhabdomyosarcoma. The client suffered from malignant fungating wounds in the terminal stage and with several clinical problems including sadness, irreversible physical dysfunction, wound drainage with odor, and pain. The nursing care conducted from 17^(th) June to 10^(th) July 2016. Data was collected via participant observation and interviews with the client and his parents. Based on Gordon's 11 Functional Health Patterns, three health problems were identified including body image disturbance, chronic pain, and anticipatory grieving. We provided a professional intervention and closely worked with multidisciplinary teams to alleviate client's discomfort, provided psychological support and techniques to improve his powerlessness, loneliness, and sadness. The case report contributes a nursing experience for the management of malignant fungating wounds and comprehensive nursing plans for adolescents with cancer in the terminal stage.

並列關鍵字

palliative care ； terminal care ； teenager ； malignant fungating wound