一位乳癌術後合併手部淋巴水腫病人的護理經驗

The Nursing Experience of A Patient with Breast Cancer and Lymphedema Following Surgery

本文描述一位乳癌術後合併手部淋巴水腫個案的護理經驗；面臨個案的手臂腫脹，化療時出現焦慮、不安及心理疲憊的情況。筆者於護理期間，經由會談、觀察、身體評估等方式收集資料，分析歸納主要健康問題為：知識缺失、身體心像紊亂、疲憊等。針對以上問題，運用主動關懷、傾聽，與個案建立良好護病關係，再引導其表達內心感受，運用醫療團隊及家人支持與介紹病友團體，經驗交換及傾訴，讓個案願意接受外觀的改變，以正向態度面對。配合使用芳香、音樂療法、運動與按摩來改善身心問題，緩解淋巴水腫不適，減輕疲憊。於後續電訪關心和追蹤其自我照顧與感受，獲得正向的生活回饋。期盼透過此次護理經驗，提供日後護理同仁提高乳癌術後淋巴水腫病人的生活品質照護。

This article describes the experience of taking care of a patient with breast cancer and severe lymphedema after following surgery. While we took care of her during the course of chemotherapy, the patient’s arm showed severe swelling with significant discomfort and she experienced uncertainty, anxiety, and fatigue. During the course of chemotherapy, we applied the worldwide Gordon 11 functional health model to assess and collect information through interview, observation, physical assessment, etc. We analyzed and summarized her major health problems as: lack of knowledge, disturbance of body image, and fatigue. To solve the above problems, we took meticulous care of her, listened to her complaints, and established a rapport with her. We also guided her to express her deeper feelings, provided knowledge related to lymphedema, applied integrated nursing care, and encouraged family support. More importantly, we introduced her to a group of breast cancer patients where she could exchange experience and information. The environment we provided allowed her to accept the changes in her physical appearance and positively face her new body image. We also provided a combination of aromatherapy, music therapy, exercise and massage to improve her mood, physical condition, and psychological perception. These reduced the discomfort from her lymphedema and reduced her fatigue. The outcomes of the integrated care were confirmed in a follow-up phone call. Hopefully, the results from this successful integrated nursing experience will provide nursing colleagues with strategies to improve the quality of life among breast cancer patients with lymphedema.