一位癌症末期病患合併腫瘤潰瘍之護理經驗

Experience in Nursing Care for Fungating Wound in a Terminal Cancer Patient

腫瘤潰揚是一種較無法癒合的傷口，病人會有較差的病程進展，也因傷口滲液、惡臭而影響外觀，若無完善的傷口照顧，不單造成身體上的不過，也是一種心理、社會的壓力來源，甚至社交或親密惑的發展受阻，醫護人員需要給予更多的照顧與關懷。本文旨在探討一位口腔癌合併腫瘤潰揚之癌症末期患者，住院期間自88 年11 月14 日至88 年12 月7 日，以Gorden 11 項功能性健康型態進行護理評估，發現個素因腫瘤潰揚傷口造成皮膚完整性受損、水腫及社交隔離等問題，而案妻在經歷個案的臨終過程出現預期性哀傷。筆者於護理過程中，應用安寧照顧理念，藉由直接護理，以主動關懷、同理心與接受等支持方式提供病患身、心、靈整體的照顧，並結合完整的傷口評估，提供舒適照顧技巧與特殊傷口護理，以維持個案腫瘤潰揚傷口的乾淨舒適，甚至滲液減少，惡臭的減除，改善其生活品質，個案在語言的表達與社會互動的量與質也相對提昇。此外，在照顧過程中也持續關注家屬的身體負荷與情緒反應，提供悲傷輔導，陪伴案妻面對病患的死亡，鼓勵說出其心中感受，進而接納死亡的事實。此照護經驗，實現安寧照顧中的身體、心理及思想三平安，與全人、全家、全隊、全程之四全照顧理念。Compared to other kinds of wounds, the fungating wound is more difficult to heal and progress is slower. The poor body image caused by exeduate and malodor from the fungating wounds not only affects patient's physical comfort, but also becomes the sources of psychological and social stress, and even interferes with the development of social performance or familiarity. Therefore, more care and attention should nurses provide for patients with fungating wounds. This case study, which uses with the eleven items of Gordon's functional health patterns, is focused on the nursing care of a terminally ill oral cancer patient with a fungating wound during his hospitalization from Nov.14 to Dec.7, 1999. The skin integrity, edema and social isolation of this patient, and anticipatory grieving of his wife were revealed as the major problems in this study. Therefore, we provided the patient with physical, psychosocial and spiritual relief by supportive treatment, such as active attention, empathy and acceptance of hospice and palliative care. Comfort care skills and special wound nursing were applied to maintain clarity and comfort through the total evaluation of the fungating wounds. As exeduate and malodor decreased, life quality, speech and interaction with society were also promoted. Furthermore, we continued to pay attention to the physical load and emotional reaction of his family, providing bereavement care, encouraging expression and help in coping with the death of the patient. All the above nursing care experiences satisfy the demands of palliative care--physical, mental and spiritual; and the characteristics of hospice--patient-centered, family-inclusive, team- coordinated and providing continuous care.