乳癌個案面臨身體心像改變之護理經驗

A nursing experience in a breast cancer cases with body image changes

本文探討乳癌個案面臨身體心像改變之護理經驗，護理期間自2017年09月08日至2017年09月14日。藉由觀察、會談及身體評估等技巧收集資料，以Gordon十一項功能性健康型態評估來確立有:皮膚完整性受損、身體心像紊亂及家庭因應能力失調之護理問題。個案在確診時面對疾病心理衝擊、自覺治療癌症花費多及家庭支持缺乏，導致逃避治療癌症，而兩年後又因腫瘤傷口惡臭潰爛，在安寧療護及疾病治療中掙扎，引發筆者書寫之動機。針對蕈狀傷口導致的惡臭、滲出液、出血，教導清洗傷口，以精油減緩異味，錄製換藥影片，提供返家照護參考，因支持系統薄弱適時關懷及同理心陪伴，透過社工資源協助找尋案母，協助建立支持系統及善終準備，並協助恢復乳房外觀視覺正常，使個案正向面對身體改變、維持舒適。腫瘤傷口敷料健保給付限制廣泛，吸附性佳的敷料多為自費且多元性，建議臨床可依個案經濟能力及個別需求，提供合適且正確的傷口照護知識，以預防及降低傷口感染，提升生活品質，回歸正常生活。

The aim of this article is to explore the nursing experience of a breast cancer cases with body image changes . Data were collected during the period from September 8, 2017 to September 14, 2017 by observation, participation and deep interview during nursing process. It was then evaluated and analyzed according to Gordon 11 functionality healthy state appraisal. The major health problems were discovered (1) Impaired skin integrity (2) Body image changes (3) Family dysfunction. At the time of diagnosis case escaping treatment because psychological impact of the disease,high cost of treatment of cancer and lack family support. After 2 years , she was considered for treatment because of the disease deteriorated. For the stench, exudate, and hemorrhage caused by the fungating wounds, taught to clean the wound, used the essential oil to slow down the odor, recorded the dressing film, and provided a reference for returning home care. Due to the support of the system's weak, gave timely care and empathy, through the social resources to help her found her mother.Assisted in the establishment of a support system and hospice, and helped restore the normal appearance of the breast, so that the case was facing the body changes and maintain comfort. Tumor wound dressings are mostly self-paying, especially for highly absorbent dressings.It is recommended that clinically provide appropriate and correct wound care knowledge according to the economic ability and individual needs of the case to prevent and reduce wound infection and improve the quality of life.