照顧一位惡性腫瘤蕈狀傷口病患之護理經驗

Nursing experiences of caring for a patient with malignant fungating wounds

本文描述一位惡性腫瘤蕈狀傷口病人照護問題，筆者於2012/11/28-2012/12/18照護期間，與個案及照顧者建立良好護病關係，藉由觀察、訪談、身體評估及直接照護，運用Gordon十一項健康功能型態評估工具，進行資料收集及整合分析，發現個案因惡性腫瘤蕈狀傷口引起味道、出血及疼痛情形，確定個案有疼痛、組織完整性受損及身體心像紊亂等三項健康問題。透過傷口照護與提供舒適護理，減少惡臭、出血及疼痛不適，並運用照顧者支持、陪伴及裝飾物使用，有效降低個案社交上的恐懼感，使其能接受，並參與傷口護理。照護期間，運用護理人員獨特功能及個別性照護措施，藉由醫療團隊及社工共同合作，陪同個案及照顧者面對病程進展。希望藉此篇個案報告護理經驗的分享，提供護理同仁往後照護類似病人之參考。

This article described the nursing issues arising out of caring for a patient with malignant fungating wounds. During the nursing period from November 28, 2012 to December 18, 2012, we established a friendly relationship with the patient and his caretaker. Through observations, interviews, physical examinations, and direct care, and by using Gordon’s eleven Functional Health Patterns, we undertook data collection and meta-analysis. We then identified that the patient had malignant fungating wound symptoms such as bad odor, hemorrhage, and pain, and defined three healthcare issues: pain, impaired tissue integrity, and body image disturbance. Through providing proper wound care and comfortable nursing experience, the odor was reduced, hemorrhage, and pain was relieved. With the support and company of the caretaker and use of decorations, the patient experienced less social apprehension and willingly accepted and participated in wound care. During the period of care, we employed the unique functions of our nursing staff and individualized procedures of nursing care, collaborated as a team with social workers, and accompanied the patient and caretaker throughout the disease course. We hope that the nursing experiences in this case will serve as a reference for nursing staff when caring for such patients in the future.