照護一位乳癌合併蕈狀傷口個案之照護經驗

Caring for a Patient with Breast Cancer Combined with Fungating Wounds

10.6880/TJON.202206_22(1).08

謝育儒(Yu-Ju Hsieh)；鄭惠蘭(Hui-Lan Cheng)

乳癌 ； 蕈狀傷口 ； 身體心像改變 ； 照顧者角色緊張 ； breast cancer ； fungating wound ； pain ； body image disturbance ； caregiver's strain

腫瘤護理雜誌

22卷1期（2022 / 06 / 01）

99 - 111

繁體中文

本文描述一位乳癌合併蕈狀傷口個案之照護過程，護理期間為2018年8月1日至2018年9月10日，運用觀察、訪談、傾聽等技巧及Gordon十一項健康功能型態評估工具，進行資料收集及整合分析，確立個案主要健康問題有：組織完整性受損、身體心像改變、照顧者角色緊張。照護期間提供合宜舒適且具個別性之換藥方式，減少傷口滲液、出血與惡臭情形，並與個案建立良好護病關係，藉由鼓勵、支持等方式，引導說出對傷口之想法，進而參與傷口換藥過程。另外，邀請病友及具經驗之家屬分享傷口照護的心路歷程及生活適應，使個案重新審視及肯定自己存在的價值與意義。針對照顧者面對居家傷口照護壓力方面，筆者將傷口換藥過程製作成簡易圖卡與影片，增強其學習成效與知能，並評估家庭支持系統，主動安排家庭會議討論照顧責任分配，成功幫助照顧者緩解壓力。期望藉由本文之照護經驗，作為臨床護理同仁照護此類個案的參考，共同提升照護品質。

This article describes the care process for a patient of breast cancer in combination with fungating wounds. The nursing period spanned from August 1 to September 10, 2018. This study uses techniques such as observation, interview, listening, as well as Gordon's 11 Health Functional Health Patterns Assessment, in order to conduct data collection and integrated analysis. The main health problems of the patient established here are as follow: impaired tissue integrity, change of mental image of the body, and caregiver role strain. Appropriate, comfortable and individualized wound dressings have been provided during nursing to reduce wound exudate, bleeding and odor. A good nursing relationship with the patient was established. Through encouragement and support, the patient was guided to talk about the wounds and then participate in the wound dressing process. In addition, fellow patients and experienced family members of other patients were invited to share the wound care experience and their way of adapting to the situation, in order to inspire the patient to re-examine and reaffirm the value and significance of his/her existence. In terms of the pressure on the caregivers for the wound care at home, straightforward picture cards and videos have been provided to enhance knowledge and increase learning effectiveness. The family support system was evaluated and family meetings were arranged to discuss the allocation of care responsibilities. Caregivers' stress was thus successfully reduced. It is hoped that through the care experience in this article, we can provide references for colleagues of clinical care when encountering similar situaitons and improve the care quality together.

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