一位口腔癌末氣切病人合併蕈狀潰瘍傷口與肺炎之護理經驗

Nursing Care Experiences of a Patient with Terminal Oral Cancer and a Tracheotomy with Fungating Wounds and Pneumonia

10.6740/NTUHJN.202101_17(1).0003

張凱婷(Kai-Ting Chang)；徐則彬(Tse-Pin Hsu)

口腔癌 ； 蕈狀傷口 ； 肺炎 ； 緩和性傷口照護 ； oral cancer ； fungating wound ； pneumonia ； palliative wound care

臺大護理雜誌

17卷1期（2021 / 01 / 01）

14 - 26

繁體中文

本文探討一位口腔癌末氣切合併蕈狀潰瘍傷口因肺炎入院接受治療之個案，護理期間為2018年9月10日至9月18日，個案住院期間除了承受癌症帶來的惡病質、疼痛、蕈狀傷口及肺部感染、發燒的不適外，還須面對非預期反覆入院的心理壓力與癌末死亡威脅，對個案與家屬皆是一個煎熬辛苦的過程，故引發撰寫動機，藉由觀察、會談、身體評估、實際照護等，確立健康問題包括現存性感染、皮膚完整性受損及預期性哀傷。藉由讓個案及家屬理解發燒過程與症狀、控制腫瘤傷口的不適症狀及學習換藥方法，讓家屬有能力照顧傷口及維持個案的舒適與清潔；透過持續傾聽、同理與陪伴讓個案表達需求及心中的感受。建議醫療院所可定期舉辦腫瘤傷口照護相關的專業進階課程，增進臨床護理師對困難傷口照護的知識與技能，以改善病人的不適症狀，提升照護品質。

This article discusses a patient with terminal oral cancer, a tracheotomy, and fungating wounds who was admitted to the hospital for pneumonia treatment. The period of nursing care was from September 10 to September 18, 2018. During the hospitalization period, in addition to the discomfort caused by cachexia, pain, fungating wounds, pulmonary infection, and fever, the patient was under psychological stress due to unexpected rehospitalization and the risk of death, which afflicted the patient and his family members. Therefore, the author was motivated to investigate. By direct nursing care, observing, conducting interviews, and performing a physical examination to collect data, the health problems, such as hyperthermia, impaired skin integrity, and anticipatory grief were identified. The patient and his family members were encouraged to learn about fever and its symptoms, how to alleviate the discomfort of fungating wounds and how to change dressings, which helped the patient's family members develop the ability to take care of the patient's wounds and provide comfort and cleanliness for the patient. During constant listening, empathy and attendance, patients' may express needs and feelings as well as venting and adjusting their emotions. We suggest that medical institutions should offer advanced health courses on a regular basis about malignant wound care to improve clinical nurses' knowledge about and skills working with complicated wounds to help alleviate patient discomfort and promote quality care.