一位合併惡性蕈狀傷口的乳癌病人接受門診放射治療期間之護理經驗

The Nursing Experience Caring for a Breast Cancer Patient with Malignant Fungating Wound during Outpatient Radiotherapy

本篇個案報告係探討一位合併惡性蕈狀傷口之乳癌病人，在發現乳房腫塊時，因初期的漠視及缺乏資訊下尋求傳統草藥治療，因而延誤適當治療時機，針對其在放射治療過程中，面臨困難傷口所帶來的身心困擾之照護經驗。筆者護理期間自2009年10月12日至12月18日，藉由身體評估、觀察、會談、傾聽等做為整體性護理評估，進行資料收集。發現個案有焦慮及因蕈狀傷口所帶來社交隔離等問題，針對其組織完整性受損之主要問題尋求醫護團隊成員共同協助，提供個別性護理措施。透過舒適及關懷照護理念，於照護過程中緩解個案生理上的不適，提供相關的資源與資訊，協助改善生活品質及促進傷口舒適，以滿足生、心、社會與靈性層面的需求，期望此護理經驗能作為日後臨床照護類似病人之參考。

This article described the experience of a nurse directly responsible for the care of a breast cancer patient with malignant fungating wound who received the radiotherapy and faced physical and psychological distress. Due to ignorance and lack of medical knowledge at the early cancer stage, the patient chose the Chinese herb treatment and missed the crucial time of surgical treatment. The author collected data through observation, physical assessment and interviews. The period of nursing care ran from October 12 through December 18, 2009. The author confirmed the nursing problems and found that the patient had impaired skin integrity, anxiety, and social isolation related to open fungating wound. The focus of nursing intervention was to provide empathy and comfort care, educate patient self wound care, and enhance social support network by giving sufficient medical information. These nursing care interventions had solved patient’s wound problem and enhanced patient’s level of comfort and quality of life. This nursing experience may provide a clinical reference in caring for such cases in the future.