一位口腔癌病人合併傷口出血之照護經驗

本文探討一位49歲口腔癌合併傷口出血個案，且具有重度疼痛之照護經驗。護理期間為2019年8月20日至9月2日，經由身體評估、觀察、會談及查閱病歷等方式收集資料。綜合生理、心理、社會及靈性層面整體性評估，發現個案有組織完整性受損、疼痛及無望感之健康問題。透過指導預防傷口出血之重要性、換藥程序，預防傷口受壓等方式促進組織的完整性。運用藥物及非藥物措施，如按摩、深呼吸、聽佛經及鋼琴音樂緩解重度疼痛。透過鼓勵個案和醫療團隊討論治療方向，建立信任及尊重個案的感受，配合心理師及志工團隊頻繁探視，使病人能以正向態度來面對後續相關照護問題，以降低無望感。建議護理師參加腫瘤照護及傷口換藥護理相關的課程，提升照護口腔癌病人的傷口、疼痛及心理問題的能力。期望藉此護理經驗之分享，增進護理師照護口腔癌病人的照護品質及提升病人的生活品質。

關鍵字

口腔癌；傷口出血；疼痛；無望感

並列摘要

This article describes the experience of caring a 49-year-old oral cancer patient with a bleeding wound. The patient experienced severe pain and hopelessness during the treatment and the nursing care spanned from August 20, 2019 to September 2, 2019. Data were collected using physical assessments, observations, interviews, and electronic medical records. Patient's health problems including impaired tissue integrity, pain, and hopelessness were identified based on his physical, mental, social, and spiritual evaluations Maintenance of tissue integrity was encouraged by educating the patient and their family about the importance of preventing further bleedingand wound compression. Wound dressing procedures was also emphasized. . To relieve severe pain, nurses provided medication and non-pharmacological interventions including acupuncture, deep breathing, Buddhist scriptures, and piano music were offered. The patient was encouraged to discuss their care plan with the medical team to establish trust and respect. The psychologist- or volunteer-visits were offered to enhance patient's positive thinking and decrease his sense of hopelessness. Lectures on oral cancer-specific care are recommended for nurses to gain confidence in facing oral cancer patients' problems, including issues on wound care, pain control, and mental health. By sharing this nursing experience, the quality of care and nurses' abilities of caring cancer patients are expected to be enhanced subsequently improving patients' quality of life.

並列關鍵字

oral cancer ； wound bleeding ； pain ； hopelessness

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