照顧一位乳癌重建復發合併蕈狀傷口之護理經驗

The Nursing Experience of Caring a Recurrent Breast Cancer Patient with Malignant Fungating Wound Post Beast Reconstruction

10.6386/CGN.202012_31(4).0010

劉香君(Hsiang-Chun Liu)；莊靜娟(Ching-Chuan Chuang)；陳淑華(Shu-Hwa Chen)

乳癌重建復發 ； 蕈狀傷口 ； 社交隔離 ； Breast Cancer ； Breast Reconstruction ； Recurrence ； MalignantFungating Wounds ； Social Isolation

長庚護理

31卷4期（2020 / 12 / 01）

571 - 581

繁體中文

蕈狀傷口是個難以癒合及複雜傷口，會有惡臭、分泌物、出血情形，對於個案不論是生理、心理、社會及靈性方面造成很大衝擊。本文探討一位乳癌重建復發合併蕈狀傷口，入院進行矽膠義乳移除手術之個案，住院期間接受傷口換藥及術後之照護經驗。護理期間自2018年10月01日至10月21日，藉由直接護理、身體評估及會談方式等技巧收集資料，運用Gordon十一項健康功能型態作為評估工具，確立個案有組織完整性受損、身體心像紊亂及社交隔離等健康問題。筆者照護期間利用跨團隊持續溝通協調方式，提供傷口照護，處理傷口惡臭、出血、滲出液情形，主動關心陪伴個案，建立良好護病關係，讓個案面對身體外觀改變及接受治療，介紹同樣疾病並且分享彼此經驗，透過親友給予心理支持及陪伴，鼓勵面對疾病，讓個案增加自信心，漸漸走入人群。建議醫療人員可參與相關傷口照顧技巧及運用跨領域團隊合作照護，讓團隊間不同的專業技能及時介入，提供個案更良好的醫療品質照護。

Malignant fungating wounds have significant physiological, psychological, social, and spiritual impacts on patients because of foul odor, excessive exudates, and bleeding. This paper described the nursing experiences in wound dressings change and the post-operative care in a malignant fungating wound of a recurrent breast cancer patient post breast reconstruction. The patient received the Mentor Memory Gel Silicone Breast Implants and hospitalized between Oct, first and 21st in 2018. We used the Gordon's 11 functional health patterns to assess nursing problems through direct care, physical assessment, and interview. We found that her nursing issues included impaired skin integrity, body image disturbance, and social isolation. We used the interdisciplinary care to communication and control wound odor, exudates, and bleeding to establish a good nursing-patient relationship. Therefore, the patient could accept the altered body image and receive treatments. In addition, the patient introduced the diseases to other patients and shared their experiences with each other. We encouraged the patient to face the diseases through our and family's mental support to help increase her self-confidence and return to regular social life gradually. It was suggested that the medical personnel could provide the relevant care skills in malignant fungating wounds and use the interdisciplinary care to help communicate and improve quality of medical services.

1. 洪玉純, Y. C.,劉姵青, P. C.,吳莉芬, L. F.,張煦婕, H. C.,何景良, C.I.,潘雪幸, H. H.(2017)。惡性腫瘤蕈狀傷口之照護。腫瘤護理雜誌，17(2)，27-35。
   連結：
2. 張沛縈, P.Y.,葉秀雯, H. W.,邱婉婷, W. T,周繡玲, H. L.(2016)。一位乳癌婦女面臨惡性腫瘤蕈狀傷口產生身體心像紊亂之護理經驗。腫瘤護理雜誌，16(1)，35-45。
   連結：
3. Gethin, G.,Grocott, P.,Probst, S.,Clarke, E.(2014).Current practice in the management of wound odour: an international survey.International Journal of Nursing Studies,51(6),865-874.
4. Jarvis, V.(2014).The range and role of palliative interventions for locally advanced breast cancer.Current opinion in supportive and palliative care,8(1),70-76.
5. Probst, S.,Arber, A.,Faithfull, S.(2013).Malignant fungating wounds-the meaning of living in an unbounded body.European Journal of Oncology Nursing,17(1),38-45.
6. Zhong, T.,Hu, J.,Bagher, S.,Vo, A.,O'Neill, A. C,Butler, K.,Metcalfe, K. A.(2016).A comparison of psychological response, body image, sexuality and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study.Plastic and Reconstructive Surgery,138(4),772-780.
7. 李安蟬, A. S.,劉慈慧, T. H.,李玉蘭, Y. L.,謝秋菊, C. C.,李佳錡, C. C(2013)。運用 Watson 人性關懷照護倫理於乳癌末期病人。高雄護理雜誌，29(3)，40-48。
8. 林雅婷, Y. T.,陳素月, S. Y.(2015)。照顧一位惡性腫瘤蕈狀傷口個案之護理經驗。高雄護理雜誌，31(1)，53-66。
9. 施佳瑢, C. J.,潘慧娟, H. C.,陳繪竹, H. Z(2016)。一位復發性乳癌個案接受乳重建手術之照護經驗。高雄護理雜誌，33(3)，38-49。
10. 彭婷瑜, T. Y.,簡慧卿, H. C.(2016)。照顧一位女性乳癌併有惡性蕈狀傷口病人的護理經驗。高雄護理雜誌，33(1)，31-41。
11. 衛生福利部 (2018，6 月 15 日 )．民國 106 年主要死因統計結果分析．取自 https://www.mohw.gov.tw/cp-3795-41794-1.html Ministry of Health and Welfare, Taiwan, ROC. (2018, June 15). Cause of death statistics, 2017. Retrieved from http://www.mohw.gov.tw/cp-3795-41794-1.html