一位乳癌患者行乳房切除併立即重建術後恢復室之照護經驗

The Nursing Experience for a Breast Cancer Patient Underwent Mastectomy and Immediate Breast Reconstruction in the Recovery Room

本文描述一位乳癌患者行乳房切除併立即重建術後恢復室之照護經驗，護理期間自2014 年12 月19 日16:00~17:20。筆者運用系統性觀察、身體評估、傾聽、治療性溝通等照護方式收集資料，確立個案護理問題有組織完整性受損、急性疼痛、舒適狀態改變與身體心像紊亂。在恢復室甦醒初期，個案因意識未清醒，產生躁動，筆者運用術後即刻護理，反覆向個案強調正確的人時地，加強定向感，床欄內放置保護墊，給予保護性約束，提供防護措施維護環境安全及避免皮瓣傷口移位壞死；利用枕頭適當支托傷口，採半坐臥姿勢，運用同理心傾聽，鼓勵家人陪伴等非藥物疼痛處置，有效降低術後疼痛；藉由穴位按摩及口腔護理來減輕麻醉後噁心嘔吐，教導深呼吸放鬆法來緩和頭暈；利用物理性冰敷，口咬碎冰塊，改善喉嚨痛；使用氣體循環式熱氣墊改善寒顫，提升個案整體舒適度；藉由含文字或圖畫的單張，提供正確照護資訊，建立個案對身體心像的正向認知，勇敢面對身體的改變。護理人員平常即應具備充足的護理知識，才能適時地提供正確資訊協助病人，建議邀請乳癌相關照護科室，成立跨團隊全人照護小組，每季舉行個案討論會議，藉由團隊討論，促進照護品質的提升。

This article described the caring experience in the postoperative recovering room for a breast cancerpatient who underwent mastectomy and immediate breast reconstruction surgery. The duration of nursingcare was from 16:00 to 17:20 on December 19, 2014. Systematic observation, physical assessment,listening and therapeutic communication care methods were employed to collect information to identitythe possible problems of the patient such as impaired tissue integrity, acute pain, discomfort and bodyimage disturbance. At the early stage of awakening from general anesthesia, patient developed restlessnessand agitation due to conscious confusion. Therefore, the author started the immediate postoperative careas the following: providing bed protection pads placed around the bed rail, giving protection constraints,providing protective measures to safeguard the environment, avoiding flap displacement and woundnecrosis, repeatedly emphasizing to the patient correct people, time, and place, in order to strengthenher orientation. We also used appropriate non-pharmacological pillow support for the surgical wound,arranged semi-lying position, used empathy to listen, encouraged family members to accompany,effectively reduced postoperative pain, provided oral care and acupuncture points massage to alleviatepostanesthesia nausea and vomiting, taught teach deep breathing relaxation method to alleviate dizziness,made use of physical ice packing and mouth chewing ice to improve sore throat, used forced-air warmingsystem to improve chillness of the patient thus to enhance her overall comfort. In addition, by leafletscontaining text and pictures, we provided proper care information, built the positive cognition of bodyimage and encouragedthe patient to be brave to face the change of her body appearance. Nurses needadequate knowledge to provide accurate and timely information to help patients. We suggested that breastcancer care related departments in the hospital can establish a multidiscipliary holistic care team that canhold a regular meeting quarterly to promote the quality of care to breast cancer patients.