照顧一位初次罹患乳癌造成手臂活動受限個案之護理經驗

The Nursing Experience of a Primary Breast Cancer Patient with Arm Mobility Disturbance

本文旨在分享照顧一位初次罹患乳癌中年離婚婦女之護理經驗。護理期間自102年9月11日至9月16日，藉觀察、會談及身體評估方式，並運用Gordon十一項功能型態評估，確立個案的健康問題有急性疼痛、焦慮、身體心像紊亂及身體活動功能障礙。於照護過程中，透過治療性關係的建立，主動傾聽個案及案兒需求，提供治療及照護資訊，降低焦慮感受。協助採取舒適臥位，減輕傷口疼痛，順利執行手臂運動；教導術後適當的穿著，改善外觀，並引導身體心像正向思考，降低身體心像改變之困擾。術後發現個案與案兒的互動少，教導按摩個案手臂及協助手臂運動技巧，舒緩疼痛，也改善親子關係。出院後追蹤，個案已配戴義乳，關節活動度增加，生活品質改善。希望藉此照護經驗之分享，提供照顧此類個案之參考。

This article describes the nursing care experience after surgery from September 11, 2013 to September 16, 2013.Data were collected through Gordon 11 Function Health patterns to identify the nursing problems, including acute pain,anxiety, disturbed body image, and impaired arm mobility. The author accompanied the primary breast cancer patientfacing disfigure to deal with physical and psychological discomforts, and helped the patient and family to resolveproblems immediately by establishing therapeutic relationship and decreasing their anxieties. The patient's pain wasrelieved by comfortable position and accompaniment of the patient to practice arm exercise. With such support, the painof her affected arm decreased. The activity function of affected arm improved with the physical team referrals and wasfollowed up appropriately after discharge. The patient can face the changes of body image with a positive attitude. It ishoped the care experience could provide the medical teams with reference for further clinic care.