照顧一位腮腺癌末期合併惡性腫瘤傷口病人之安寧居家療護經驗

The Home-Based Hospice Palliative Care Experience of a Terminal Patient with Malignant Tumor Wound of Parotid Gland Carcinoma

本文描述一位腮腺癌末期合併惡性腫瘤傷口病人之護理經驗，照護期間自2014年3月26日至2014年5月10日，以Gordon十一項健康功能型態評估工具，進行整體性評估及資料整合分析後，確立病人有慢性疼痛/與腫瘤壓迫及傷口換藥有關、組織完整性受損／與腫瘤導致潰瘍傷口及臥床不動有關、預期性哀傷/與病況惡化有關等三項健康問題。護理過程中藉由正確的疼痛評估，給予止痛藥物控制及給予放鬆技巧來減輕疼痛不適，並提供病人合適的換藥方式、配合精油除臭及止血藥物使用，減輕傷口惡臭及出血。採持續性照護及主動關懷個案、傾聽家屬的感受，與個案、家屬建立良好的護病關係，讓家屬彼此達成共識，使個案在生命的最後階段平靜安詳度過。

This article describes the nursing experience of assisting a patient with fungating tumor wound as a result of parotid gland carcinoma. The nursing care period was between March 26th and May 10th, 2014. Nursing assessment was based on the Gordon's Eleven Functional Health Patterns. Three health problems were identified, including pain, impaired tissues integrity, and anticipatory grief. During the nursing process, we assessed the level of pain, administered pain medications, and provided relaxation techniques to relieve pain and discomfort. By choosing appropriate dressings and applying essential oil and hemostatic drugs to the wound, we were able to reduce the malodorous smell and stop the bleeding. Continuity of care was ensured and the patient's and family members' concerns were attentively listened to. Therefore, a good nurse-patient/family rapport was established. The family was able to reach a consensus regarding care decision so that the patient underwent the terminal stage of life with calm and serenity.