一位乳癌合併腹膜轉移病人之照護經驗

本文探討一位44 歲乳癌合併腹膜轉移病人之照護經驗。於2014 年04 月01 日至2014 年04月20 日間，筆者以身體評估、會談及實際照護方式收集資料，並運用Gordon 十一項功能性健康型態評估歸納個案有組織完整性受損、營養少於身體所需及焦慮之護理問題。筆者應用造口照護的原理解決胃造瘻管傷口滲出消化液的問題，不僅使皮膚損傷範圍逐漸縮小，個案也能放心外出參與社交活動。筆者促使醫療人員及早提供全靜脈營養、營養師訂立飲食計劃並選擇羹湯以增加營養被吸收的程度，讓個案體重穩定成長。在焦慮之照護方面，以誠懇的態度回應個案詢問同樣的問題，聆聽梵音音樂，達到緩解個案緊繃的情緒。管路傷口照護是護理的獨立功能之一，建議未來能觀察長期效果，或是以研究型式擴大樣本數，更進一步地瞭解該傷口照護的優點和限制。

關鍵字

乳癌；腹膜轉移；胃造瘻管傷口

並列摘要

The article discussed the experience in looking after a 44-year-old patient with breast cancer combined with peritoneal metastasis. Being the primary nurse, the author looked after the patient from April 1st to April 20th, 2014, collected data by means of physical assessment, interviews and actual care, and summed up such nursing problems as impaired tissue integrity, nutrition less than the body requirements, and anxiety. The author applied the principle of stoma care to resolve the problem where digestive juice was oozing from the gastrostomy tube. This not only gradually reduced the skin injury area, but also allowed the patient to go out for social activities with a relaxed mind. The author makes medical staff was able to provide total parenteral nutrition (TPN) as early as possible, establish a diet plan and choose thick soup to increase the nutrient absorption rate, enabling the patient’s weight to increase stably. Concerning anxiety relief, the author sincerely responded to the questions the patient asked and played Buddhist music to ease the patient’s tension. The care of canal wounds is one of the independent functions of nursing. Observation of the long-term effects is advised for future study, or expansion of the patient sample number in research scale will contribute to further understanding regarding the advantages and limitations of such wound care.

並列關鍵字

breast cancer ； peritoneal metastasis ； percutaneous endoscopic gastrostomy wound

參考文獻

郭弘揚、郭冠廷、徐志宏(2014)．侵襲性小葉狀乳癌的反覆腸胃道轉移．台灣癌症醫學會雜誌，30 (1)，41-47。 doi: 10.6323/JoCRP.2014.30.1.5

林哲斌、周碧瑟、璩大成(2013)．侵襲性乳癌之預後因子．北市醫學雜誌，10 (2)，10-19。doi: 10.6200/TCMJ.2013.10.2.02 doi: 10.6200/TCMJ.2013.10.2.02

李思蓉、陳璟賢、楊妹鳳、張基晟(2012)．探討營養介入對癌症患者營養狀況與持續接受抗癌治療影響之相關性．台灣營養學會雜誌，37 (2)，51-65。

Burch, J. (2011). Peristomal skin care: The essentials of good care. British Journal of Nursing, 20 (4),208-209. doi: 10.12968/bjon.2011.20.4.208

Han, Y. M., Kim, C.Y., Yang, D. H., Kwak, H. S.,& Jin, G. Y. (2006). Fluoroscopically guided feeding tube insertion for relief of postoperative gastrointestinal anastomotic obstruction and leakage. Cardiovascular and Interventional Radiology, 29 (3), 395-400. doi: 10.1007/s00270-005-0095-z

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一位乳癌合併腹膜轉移病人之照護經驗

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