協助一位乳癌婦女面臨乳房重建失敗之護理經驗

The Nursing Experience of a Breast Cancer Woman with Breast Reconstruction Failure

乳房重建可協助乳癌婦女重建身體完整性，恢復生活品質。少數病人因發生術後合併症而面臨乳房重建失敗，進而影響患者對疾病的調適。本篇報告描述照護一位接受立即性乳房重建之乳癌婦女，因義乳感染面臨重建失敗之護理經驗分享。護理期間為2011年10月12日至11月10日，筆者為整形外科個案管理師，藉由會談、評估與醫療團隊討論，於個案術前門診、住院期間及術後追蹤，運用Gordon十一項護理評估，進行資料收集。確立個案有「組織完整性受損」、「焦慮」及「身體心像紊亂」等健康問題。護理期間運用傾聽、陪伴，與個案建立信任感，提供專科性之傷口照護，終有良好結果呈現；對於術前的疑慮，與醫療團隊討論並詳細解說，減緩個案心中焦慮；心理調適方面，誘導個案主動說內心的感受，鼓勵親人陪伴，並提供相關支持團體，使個案能坦然面對疾病傷害與身體外觀的改變，並勇敢走向人群。希望藉此個別性的護理經驗，提供護理人員未來照顧類似個案之參考。

This case report highlighted the nursing care experiences for a woman with breast cancer undergoing immediate breast reconstruction (IBR) with reconstruction failure. Breast reconstruction can help breast cancer women feel wholeness and restore the quality of life. However few cases have adapted the consequence of failure. During the nursing period from October 12 to November 10, 2011. During preoperative, postoperative and clinic care period, Gordon's functional health assessment guide was used to analyze data. The author, as a case manager used interview, observation, conversation, physical examination, and discussion with the team of medical care for data collection. The nursing problems identified included impaired tissue integrity, anxiety, and disturbance of body image. The author provided comprehensive nursing management, such as provided psychological support, specific reconstruction wound care, whole team work and family/social supportive group to assist the patient alleviate anxiety facing the breast cancer and the change of body appearance. There was lack of literature related to this subject so far. The experience provided nursing colleagues reference for caring patients with breast reconstruction in the future.