一位口腔癌合併蕈狀傷口患者的照護經驗

The Nursing Experience of an Oral Cancer Patient with Fungating Wound

本文探討一位55歲口腔癌合併蕈狀傷口個案之護理過程，因個案無法忍受腫瘤蕈狀傷口造成的長期疼痛、惡臭等問題而入院就醫，護理人員試行新型換藥方式，成功處理傷口惡化的護理經驗。筆者於2012年12月10日至12月21日之照護期間，運用羅氏適應模式評估，確立個案的主要護理問題有組織完整性受損、慢性疼痛及無力感；護理過程中依傷口性狀採取新型換藥方式、提供減低傷口惡臭的措施、執行有效的疼痛處置，在個案及家屬共同執行下確實達到減輕傷口惡化及疼痛情形；進一步處理個案因傷口急速惡化，對疾病缺乏控制感所產生的無力感問題，經護理措施介入後，個案逐漸展開笑容接受治療。筆者希望藉由此成功的經驗提供癌症單位護理人員在口腔癌合併蕈狀傷口患者疼痛處置及傷口照護之參考，讓患者及家屬獲得更舒適的照護，提升生活品質。

In this article, we described a male oral cancer patient complicated with a fungating wound who was admitted due to intolerance of severe wound pain and foul smell. We shared the nursing experience of successful management of wound pain with a new type of wound dressing. From Dec 10th to Dec 21st 2012, under the Roy’s adaptation model of nursing, the authors assessed the patient having problems of impaired tissue integrity, chronic pain, and weakness. During the process, after discussion amongst the medical team, we carried out efficient pain management, implemented a new type of wound dressing, and offered a procedure to diminish the foul smell of the wound. The pain and condition of the wound improved after the patient and his family learned the procedure. Furthermore, we reduced the rapid wound deterioration as well as the patient’s feelings of helplessness caused by lack of control over his condition. After the intervention of the nursing procedure, the patient gradually accepted the treatment with a smile. The authors would like to share this successful experience as a reference to offer nursing personnel in cancer units for pain management and wound care for oral cancer patients with fungating wounds. It could offer more comfortable care and improve quality of life for patients and their families.