一位乳癌切除後執行乳房重建之手術全期護理經驗

An Experience in the Perioperative Nursing Care for a Patient Admitted for Breast Reconstruction Post Mastectomy

本文描述一位43歲女性已切除乳房四年，入院行乳房重建手術全期之護理經驗，護理期間為2013年5月1日至5月3日，藉由觀察及訪談技巧並依據手術全期護理架構為指引，進行整體性評估後，確立病人的護理問題為：焦慮/與手術過程及未知的結果；潛在危險性手術情境傷害/與麻醉制動姿勢擺位、器材殘留、使用電燒筆；危險性體溫過低/麻醉及身體大範圍長時間暴露於空氣中及未加溫靜脈輸液有關。筆者在照護過程中，運用同理心建立良好的護病關係，於手術前訪視給予支持與鼓勵，並詳細說明乳房重建手術流程及相關照護，增加病人對手術的認知，減輕焦慮不安情緒；手術中期維持舒適安全的手術環境，正確計數各項器械、敷料，以預防潛在危險性傷害，減少不必要暴露及適度的保暖，穩定病人體溫於正常範圍，以利手術過程順利，降低合併症的產生。藉此護理經驗的分享，提供手術護理人員照護此類病人參考。

A 43-year-old female patient having a mastectomy for 4 years was admitted from the 1st to the 3rd of May in 2013. The authors conducted an overall assessment via observation and interview strategies according to the guidelines of perioperative nursing care. They then established the patient’s potential health problems, including (1) anxiety/with the surgical procedures and the unknown operative outcomes related; (2) potential harm from the surgery/anesthesia supine position retained; electrocautery knife related; and (3) hypothermia/general anesthesia and not warmed; intravenous fluids related. The authors established a good nurse-patient relationship holding in an empathy manner during this caring period. Before the operation, they supported and encouraged the patient. They also explained the details of the surgery and the post-operation care plans. These improved the patient’s knowledge of the surgery and alleviated her anxiety. Throughout the operation, via maintaining a safe and comfortable environment, complying with all safety protocols, as well as monitoring constantly the patient, they reduced the possibility of complications the patient might have. By sharing this nursing care experience, the report provides a reference for taking care other patients with a similar situation in the future.