照護一位乳癌末期合併出血性蕈狀傷口之護理經驗

Nursing Experience of an End-Stage Breast Cancer Patient with Malignant Fungating bleeding Wounds

本文描述一位乳癌末期病人合併出血性蕈狀傷口引發身心困擾及照顧者角色緊張之護理過程。筆者於2015年11月16日至11月30日以Gordon十一項健康功能型態進行完整性護理評估，確立個案有「組織完整性受損」、「身體心像改變」及「照顧者角色緊張」之護理問題。護理過程中，因為個案腫瘤蕈狀範圍佈滿整個胸部且容易出血，筆者先給予傷口溫敷再採漸進式以春捲手法移除沾黏的敷料，控制傷口出血及滲出液的情形；藉由適時陪伴與用心傾聽個案，同時轉介腫瘤心理師，與個案建立了濃厚的互信關係，協助個案面對身體心像改變所造成之困擾；利用手機 Application增加文字及線上沖印照片功能，製作個別性傷口照護相本、轉介返家後專業照服員及居家護理師、鼓勵個案參與傷口照護，以減輕照顧者照護壓力；爾後希望製作蕈狀傷口照護影片及標準流程，供更多的護理人員學習及重視腫瘤蕈狀傷口，藉此真正幫助到更多的癌症病人。筆者藉由此次照護經驗，護理人員在照顧上能提供個別性護理讓病人得到身心靈完整照護。

This paper describes the nursing experience for a terminal breast cancer patient withfungating bleeding wounds that caused mental-physical strain on the caregiver. During thenursing period from November 16, 2015 until November 30, 2015, the use of Gordon's 11Functional Health Assessment showed that the patient's nursing problems were impairedbody integrity, body image disturbance, and strain upon the caregiver. During the nursingprocess, the fungating wounds ranged throughout the whole chest and would bleed easily.The author first slightly raised the temperature of the wound using a warm cloth then removeddressings in a progressive technique of rolling the dressing to avoid and control the bleedingof the wound. Through referral of the patient to a psychologist, the case was able to establisha bond of trust, as well as improve their perception of their own body. Using a mobile phoneapplication to increase the record of texts and photographs regarding individual wound care,the patient and attendants were able to provide wound care without psychological stress andpressure. The goal for the future is to create wound care videos for fungating wounds andstandardizing the process of wound care. Through this, patients with such wounds will feelmore at ease due to better informed care-givers and will also reduce the pressure of caregiversin similar situations.