一位乳癌末期婦女合併惡性蕈狀傷口疼痛之照護經驗

Nursing Care for Advanced Breast Cancer Female Patient with Fungating Wound Pain

10.6880/TJON.201812_18(2).05

陳曉慧(Hsiao-Hui Chen)；林佩昭(Pei-Chao Lin)

乳癌 ； 惡性蕈狀傷口 ； 疼痛 ； 身體心像改變 ； 預期性哀傷 ； breast cancer ； fungating wound ； pain ； body image disturbance ； anticipatory grief

腫瘤護理雜誌

18卷2期（2018 / 12 / 01）

47 - 57

繁體中文

乳癌病人面對病程惡化且伴隨惡性蕈狀傷口疼痛，經常衍生心理與靈性問題。本文描述一位乳癌末期婦女面對惡性蕈狀傷口與死亡衝擊的護理經驗。護理期間為2016年3月2日至4月30日，筆者透過觀察、會談、身體評估等方式收集資料，確立病人主要護理問題為慢性疼痛、身體心像紊亂、預期性哀傷。筆者教導疼痛控制的技巧，並藉由肢體按摩、音樂療法等措施緩解疼痛，增進睡眠品質；選擇適合敷料、使用茶樹精油，改善病人傷口異味，協助個案面臨身體形象改變所造成困擾；持續與醫療團隊共同陪伴、傾聽病人內心想法，降低病人及女兒的哀傷情緒，接受面臨死亡過程，以達善終。建議護理人員，能配合安寧緩和醫療團隊共同照顧，使癌末病人最終旅程能有更佳照護品質。

Female breast cancer patients with worsening disease course and pain associated with fungating wound often develop psychological and spiritual issues. This paper describes a nurse's experience of caring for a women with advanced breast cancer. From March 2 to April 30 of 2016, the first author collected data through observation, interviews and physical examination to identify the patient's health problems which are chronic pain, body image disturbance and anticipatory grief. The first author provided nursing interventions by offering patient education on pain control skills, body massage and music to help patient relieve pain and improve sleep quality; author also used the appropriate dressing selection and tea tree oil to improve wound odor and assist patient to face the body image disturbance. The constant support from the medical team through listening to the patient's thoughts helped reduce patient's and her daughter's grief and then accept the dying process and hospice. This paper recommends that nurses can work with the palliative care team so that the terminal cancer patients can have better quality of care in their final days.

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