一位行乳房重建個案之手術全期護理經驗

A Perioperative Nursing Experience of a Post Mastectomy Patient Undergoing Breast Reconstruction

本文探討一位乳癌切除後執行食鹽水袋義乳重建個案之手術全期護理經驗。照顧期間自2018年10 月2 日至10 月3 日，筆者以觀察、會談、身體評估及病歷查閱等方式收集資料，並運用手術全期護理模式進行整體性健康評估，確立個案之健康問題有：身體心像紊亂、焦慮、潛在危險性手術情境傷害、組織完整性受損、潛在危險性感染及急性疼痛。筆者藉手術前訪視，提供乳房重建相關資訊，緩解個案焦慮及乳癌切除後所導致之身體心像衝擊；透過姿勢擺位、預防異物存留及安全維護，使個案免於潛在危險性手術情境傷害及手術中感染；經給予止痛劑、教導執行放鬆技巧及義乳照顧、與病房主護護理師交班，緩解個案疼痛及手術後傷口感染控制問題。期望此護理經驗能提供日後照顧此類患者參考。

"The purpose of this article was to describe a perioperative nursing experience of a post mastectomy patient undergoing breast reconstruction with saline-filled implants. From October 2 to October 3, 2018, data were collected through observation, interview, physical assessment, and chart review according to a comprehensive assessment with perioperative nursing model as guideline. The nursing problems identified included body image disturbance, anxiety, risk for perioperative-positioning injury, impaired tissue integrity, high risk for infection, and acute pain. By providing preoperative visiting and giving information about breast reconstruction, the author relieved the patient’s anxiety and the impact of body image after breast resection. Through posture position, preventive inadvertent retention of foreign material, and safety maintenance, the author avoided the risk for perioperative-positioning injury and infection during surgery of the patient. By giving analgesics, relaxation techniques, prosthetic breast care, and working with primary nurses, the author relieved the patient’s pain and post-surgery wound infection control problems. Hopefully, this nursing experience can serve as a reference for taking care patients with a similar situation in the future."