照護一位乳癌術後合併急性腋下淋巴水腫病人之門診護理經驗

Experience in Outpatient Care of a Patient with Postoperative Breast Cancer and Acute Axillary Lymphedema

本文敘述一位初診斷乳癌55歲女性，接受乳房手術合併急性腋下淋巴水腫之門診護理經驗。護理期間為2023年2月7日至5月18日，依生理、心理、社會及靈性進行整體性評估，以Gordon十一項健康功能評估做架構，歸納有「急性疼痛」、「身體活動功能障礙」、「身體心像紊亂」等健康問題。個案在面對癌症初次診斷時，內心感到徬徨無助，手術後，更經歷傷口急性疼痛及腋下淋巴水腫，導致身體活動受限和身體心像紊亂。就醫期間，針對術後傷口及引流管引起的疼痛，提供適當鎮痛藥物及舒適度調整，幫助恢復日常活動。乳房切除導致的身體變化帶來心理困擾，運用同理心傾聽並透過病友經驗分享與家庭支持幫助其逐步接受術後變化。對於術後淋巴水腫，提供個別化運動指導，幫助進行淋巴引流運動，並指導正確的護理措施以減少水腫，提供個案門診乳癌照護團隊、乳癌團體相關資訊之轉介資源，持續關心個案病況及後續復健情形及電訪追蹤，協助早日回歸原有角色功能及自信心。希望藉此護理經驗，提供護理同仁照顧類似個案之參考。

This article describes the nursing management of a 55-year-old female patient diagnosed with breast cancer who underwent mastectomy and subsequently developed acute axillary lymphedema. The nursing care spanned from February 7 to May 18, 2023. A comprehensive assessment was conducted, addressing the patient’s physical, psychological, social, and spiritual well-being, utilizing Gordon’s Eleven Functional Health Patterns as a framework. Key health issues identified included ''acute pain,'' ''impaired physical mobility,'' and ''disturbed body image.'' Upon receiving her initial cancer diagnosis, the patient experienced feelings of confusion and helplessness. Postoperatively, she suffered from acute pain at the surgical site and developed axillary lymphedema, which impaired physical mobility and exacerbated body image disturbances. During her outpatient visits, appropriate pain management and comfort interventions were provided to address the surgical wound and drainage tubes, facilitating her return to daily activities. The physical changes associated with mastectomy led to psychological distress; empathetic communication, alongside peer support and family involvement, was employed to help the patient gradually accept the postoperative changes. Regarding the postoperative lymphedema, individualized exercise programs were implemented to promote lymphatic drainage and correct care techniques to alleviate swelling. Referral information to outpatient breast cancer care teams and support groups was provided, and continuous follow-up care was maintained through phone calls to monitor her recovery and rehabilitation progress. The overarching goal was to assist the patient in regaining her pre-diagnosis functionality and self-confidence. This nursing experience aims to serve as a reference for nurses managing similar clinical cases.