照顧一位唾液腺癌末期併惡性蕈狀傷口個案之安寧居家護理經驗

Nursing Experience of a Patient With Malignant Fungating Wounds and Terminal Stage Salivary Gland Cancer Receiving Hospice Home Care

10.6142/VGHN.201809_35(3).0004

曾士嬴(Shih-Ying Tseng)；李彩緣(Tsai-Yuag Li)；陳明玉(Ming-Yu Chen)

惡性蕈狀傷口 ； 安寧照護 ； 居家護理 ； malignant fungating wounds ； hospice and palliative care ； home care

榮總護理

35卷3期（2018 / 09 / 01）

253 - 260

繁體中文

安寧居家護理的目的在提供持續性安寧照護，協助其獲得身心靈之症狀緩解以提高生活品質。本文為描述一位91歲高齡唾液腺癌末期併有惡性蕈狀傷口個案之安寧居家照護經驗。護理期間於2016年6月3日至2016年11月29日，經由生理、心理、社會及靈性層面評估，發現個案因唾液腺癌併蕈狀傷口導致「組織完整性受損」、「慢性疼痛」及「預期性哀傷」等主要護理問題。護理期間經由增進照護者的技能來降低個案傷口出血、惡臭、感染及疼痛情形；藉由階段性調 整止痛藥物，並協助採舒適臥位及按摩方式，緩解個案的慢性疼痛；適時陪伴同理，引導個案表達面對死亡的哀傷，促進個案與家人及醫療團隊的互動，並鼓勵以信仰支持個案重整生命與提升靈性慰藉，能平靜走完人生旅途得以善終。

The purpose of hospice home care is to provide continuous patient care, thus relieving physical and mental symptoms and improving the patient's quality of life. This article describes the experience of hospice home care for a 91-year-old patient with terminal salivary gland cancer and malignant fungating wounds. The period of care lasted from June 3 to November 29, 2016. Physical, psychological, social, and spiritual assessment revealed multiple health problems, such as impaired skin integrity, chronic pain, and anticipatory grieving. During the care period, hemorrhage, malodor, infection, and pain were reduced through the promotion of the wound care skills of the caregiver. Chronic pain was alleviated through the adjustment of analgesic drugs accompanied by supine massage methods. The patient received a high quality of end-of life care to guide him to face the anticipatory grieving, increase his interactions with his family with the medical team, and support his faith.

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