照顧一位乳癌末期合併腫瘤蕈狀傷口病人之護理經驗

Nursing Experience of Caring for a Patient with Breast Cancer and Malignant Fungating Wounds

10.6740/NTUHJN.202007_16(2).0006

鄭旭倩(Hsu-Chine Cheng)；陳宜珊(I-San Chen)

蕈狀傷口 ； 乳癌 ； 死亡焦慮 ； 癌症末期 ； fungating wounds ； breast cancer ； anticipatory grief ； terminal stage

臺大護理雜誌

16卷2期（2020 / 07 / 01）

53 - 63

繁體中文

本文探討照顧一位乳癌末期病人面對乳房蕈狀傷口之護理經驗，於2016年8月20日至9月6日護理期間，藉由直接照護、觀察、治療性會談與身體評估等方式進行資料收集，運用生理、心理、社會及靈性層面收集資料進行評估與分析，發現個案有組織完整性受損、身體心像紊亂、死亡焦慮之健康問題。護理過程中會診傷口照護護理師，透過適當的敷料選擇及美化傷口方式，使腫瘤蕈狀傷口乾燥並降低惡臭，減輕個案因腫瘤蕈狀傷口的疼痛不適，促進面對死亡焦慮的有效溝通。運用同理心及支持性心理照顧技巧，協同心理師運用生命回顧等措施，幫助個案逐步接受對死亡的失落與恐懼，促進個案及家屬對乳癌末期病程的認知，以「四道人生」為目標，透過醫療跨領域合作，提供完整性照護，使個案最後能善終，達到生死兩相安的使命。希望藉此護理經驗分享，能提供醫療團隊對於癌症末期個案具體之照護措施，以增進個案之生活品質。

This article described the nursing care experience of a terminal breast cancer patient with deteriorating malignant fungating wounds. Data were collected using direct care, observations, therapeutic talks, and physical assessments between August 20 and September 6, 2016. Four healthcare issues were defined: impaired tissue integrity, pain, body image disturbance, and anticipatory grief. We consulted a wound care specialist to dry the wound and reduce stench. To encourage the patient to face the wound, and to reduce her fear of death, we made an effort to establish companionship and provided psychological support. We used life review to help the patient accept the loss and fear of death in order to achieve the ＂four lives＂. After the comprehensive nursing care, good death and her mission in life were achieved. We hope to share the nursing care experiences of this case with medical teams for improving terminal cancer patients' quality of life.

1. 柯苡含(Yi-Han Ke);王淑麗(Shu-Li Wang);李筠涵(Yun-Han Lee)(2024)。運用醫病共享決策於乳癌抉擇衝突個案之照護經驗。高雄護理雜誌。41(1)。124-134。