一位乳癌婦女面臨惡性蕈狀傷口產生身體心像紊亂之護理經驗

Nursing Experiences of Disturbed Body Image With a Malignant Fungating Wounds Female Patient in Breast Cancer

10.3966/168395442016061601005

張沛縈(Pei-Ying Chang)；葉秀雯(Hsiu-Wen Yeh)；邱婉婷(Wan-Ting Chiu)；周繡玲(Hsiu-Ling Chou)

乳癌 ； 惡性腫瘤蕈狀傷口 ； 疼痛 ； 身體心像紊亂 ； breast cancer ； malignant fungating wound ； pain ； disturbed body image

腫瘤護理雜誌

16卷1期（2016 / 06 / 01）

35 - 45

繁體中文

乳癌病人併有惡性腫瘤蕈狀傷口時，除了生理上的不適，外觀改變及傷口惡臭，進而產生羞愧自卑感，嚴重影響原有的社交活動。本篇探討一位乳癌婦女因面臨難以癒合的惡性腫瘤蕈狀傷口，住院期間所引發的身、心、靈等問題，護理期間自2013年03月17日至04月13日，藉由與個案訪談、身體評估、觀察照護等方式，運用Gordon十一項健康功能型態，發現惡性腫瘤蕈狀傷口對個案身體心像紊亂的衝擊，包括：疼痛、惡臭、低自尊、社交隔離。護理過程選用合宜的傷口敷料、環境調控及護理技術，吸附傷口滲出液及緩解出血，減少傷口惡臭情形，在疼痛控制方面，除了藥物外，運用淋巴按摩、芳香療法、放鬆技巧來緩解身體疼痛。同時，以主動關懷、同理心等照顧技巧，與個案建立信任感，促使病人分享心理及靈性需求，重拾自信心及接受自己身體外觀的改變，達到傷口自我照顧及接觸人群目的。藉由此護理經驗之分享，作為日後照護類似病人之參考。

This article shares the nursing experience of a female breast cancer patient who suffered from physical, psychological, and spiritual issues stemmed from malignant fungating wound. The nursing care period was from March 17 to April 13, 2013. Data were collected through direct patient care, interviews, observation and physical assessment of the patient's health condition. Gordon 11 Functional Health Patterns was utilized to identify the patient's health concerns, such as disturbed body image, pain, malodor, low self-esteem, and fear of people contact. Seaweed dressing was used to absorb the discharge from the wound so that the patient could stay dry from seepage, which would also decrease the times of dressing change; tea-tree oil was applied, along with aromatherapy and an air cleaner, to decrease the effect of wound odor,; medications plus lymphatic massage, aromatherapy, and relaxation techniques were used to relieve patient of the wound pain. We built trust with the patient and her family by showing that we cared and through display of empathy. The presence of trust helped patient to stop feeling ＂caged in＂ or isolated, so patient could start building a sense of self-confidence. We hope our nursing experiences can be used as a reference for the care of patients with oral cancer, and thus promote the quality of patient care.

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