一位口腔癌復發合併惡性蕈狀腫瘤傷口病人之護理經驗

Nursing Experience of Caring for a Patient With Recurrent Oral Cancer and Malignant Fungating Wounds

10.6142/VGHN.202112_38(4).0009

黃郁婷(Yu-Ting Huang)；黃心慈(Shin-Tsyr Huang)；紀米娟(Mi-Chuan Chi)

口腔癌 ； 疼痛 ； 無望感 ； oral cancer ； pain ； hopelessness

榮總護理

38卷4期（2021 / 12 / 01）

406 - 412

繁體中文

本文探討一位62歲男性口腔癌合併惡性蕈狀腫瘤傷口病人的護理經驗。筆者於2019年4月18日至2019年5月11日照護期間，運用直接護理、觀察、會談及病歷查閱等方法收集資料，依生理、心理、社會與靈性層面進行整體性評估，確立病人主要健康問題有組織完整性受損、疼痛及無望感等。護理期間筆者先與病人及其家屬建立信任的護病關係，給予主動關懷、傾聽、正向鼓勵與心理支持引導病人適時表達情緒，並照會傷造口護理師及心理師等跨團隊之照護服務，應用實證護理文獻提供符合病人之傷口換藥方式。再者，透過與醫療團隊探討病人疼痛問題，以選擇合適的止痛藥物介入。而腫瘤傷口照護具特殊性及難度，護理師受限傷口照護訓練較不足，無法及時提供合適之換藥處置，建議未來能設置腫瘤傷口照護之線上影像諮詢或3D數位傷口相關教育課程，除了提升臨床護理師傷口照護能力外，更能讓護理師在面對各種腫瘤傷口時，即早進行合適之傷口換藥處置，以協助改善其健康問題。

In this paper, we present the experience of nursing a 62-year-old man with a diagnosis of oral cancer with malignant fungating wounds. Between April 18 and May 11, 2019, we collected data through our own practical nursing, observation, interviews, and a medical record review. We determined that the major health problems were tissue damage, pain, and a feeling of hopelessness. During the nursing period, we established a rapport with the patient and his family through active care, listening, encouragement, and emotional support. Additionally, we consulted multiple experts, such as wound and ostomy nurses and psychological counselors in different fields, for interdisciplinary collaboration. Evidence-based nursing literature was also consulted for suitable wound dressing approaches, and we guided the patient to express his emotions appropriately. Furthermore, we selected suitable analgesics to address wound pain through discussion with the medical team. However, malignant wound care is both unique and complex and is often difficult to manage properly. The nursing staff were often unable to provide prompt and effective management of the wound dressings because of a lack of training in wound management. Therefore, we suggest the establishment of an online image library for malignant wound care or 3D simulation for wound management courses. Such training should improve not only skills related to cancer wound care but also the ability to apply proper wound dressings to improve the patient's health.

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