照顧一位會陰癌婦女接受顯微重建手術之護理經驗

本文為照顧一位初次罹患會陰癌第三期中年婦女，接受根除性會陰部切除及皮瓣重建手術後，面臨生理及心理衝擊之護理經驗。護理期間自2019年6月13日至2019年6月17日，透過直接照護、觀察、會談、理學檢查及身體評估等方式，收集主、客觀資料。運用Gordon十一項功能性健康型態評估個案，確立健康問題包括：疼痛、組織完整性受損、焦慮。運用同理心及真誠的態度，與個案及家屬建立良好的護病關係，並藉由個別性護理措施、醫療處置緩解生理問題，適當使用止痛藥物及採肌肉放鬆技巧減緩疼痛、協助傷口換藥及飲食衛教促進傷口癒合，並以同理關懷、支持陪伴，適時關心需求，透過多元衛教如模型、圖片方式進行護理指導，除改善生理問題，也減輕對手術治療的焦慮。臨床建議安排固定之照護人員並個案管理師進行關懷及病友提供支持，協助個案復原，冀望透過此護理經驗，提供臨床護理人員照護婦女癌症之參考。

This article delves into the nursing experience concerning the physical and psychological challenges faced by a middle-aged woman newly diagnosed with stage III vulvar cancer, who underwent radical perineal resection plus flap reconstruction. The nursing care period extended from June 13th to 17th, 2019. Employing direct care, observation, interviews, physical assessments, and Gordon's functional health patterns as an assessment framework, the author gathered data regarding pain, impaired tissue integrity, and anxiety through observations, interviews, and physical examinations. Individualized care plans, coupled with empathy and a genuine attitude, were developed to establish a supportive nursepatient relationship with the patient and her family. The author provided tailored nursing interventions and medical treatments to address both physical and mental health issues. Patients and their families were encouraged to utilize analgesics and muscle relaxation techniques to alleviate pain. Family involvement in wound dressing and dietary adjustments was facilitated to promote the patient's wound healing, following the author's guidance. Reflecting on this nursing experience, it was concluded that providing various aids such as molds or pictures as nursing guidance not only aids in addressing patients' physiological issues but also alleviates their anxiety surrounding surgical treatment. Clinical recommendations include assigning dedicated care staff, a case manager, and facilitating connections with patients sharing similar diagnoses to provide ongoing support. This article aims to serve as a reference for healthcare professionals caring for patients with gynecologic cancer.