照顧一位植入性胎盤且次子宮全切除初產婦之護理經驗

Nursing Care of a Primipara Implanted with a Placenta Accreta and Undergoing Subtotal Hysterectomy

懷孕是段充滿未知的旅程，若此時發現植入性胎盤且有早產脅迫，孕婦得面對大量出血，可能子宮必須全切除，導致生育能力喪失的威脅外，若處理不當，甚且可能危急自身的生命，最後，還得擔憂早產寶寶，發育不成熟，其後可能的健康問題等，都讓產婦身心飽受煎熬，故引發筆者探討動機。本文運用羅氏理論，探討一位穿透性植入性胎盤，於36週早產，且須接受次子宮全切除初產婦的照護過程，於2017年2月3日至2017年2月6日，透過直接照護、身體評估、觀察、會談及病歷查閱等方式收集資料，確立個案護理問題有疼痛、身體心像改變、焦慮等。透過教導正確使用束腹帶與轉移注意力的方法，以減輕疼痛；衛教自我觀察異常徵象的能力，提高自我照顧的自信心，並鼓勵說出對子宮切除的擔心，以抒發其對身體心像改變之負向情緒；並協助執行袋鼠式護理、鼓勵個案觸摸早產兒及提供早產兒照護技巧等增加親子依附關係，以減輕焦慮。照護過程中，有鑒於病房缺乏有關母乳庫的衛教單張，建議病房可制定有關母乳庫之衛教單張，以供未來病人需要時取用。 Pregnancy is a life experience characterizedby uncertainty. Pregnant women with placentaaccreta who are at risk of pre-mature deliverymay face severe hemorrhage. Their uteri mayneed to be fully removed, costing them theirfertility. If their conditions are improperlymanaged, their lives may be at risk. Inaddition, because their premature infants arenot completely developed, the infants mayface subsequent health problems, creating apsychological burden on the mothers. Thispaper describes the nursing care provided to aprimipara with placenta accreta who deliveredprematurely at 36 weeks and who had toundergo subtotal hysterectomy through Roy´sadaptation model. From February 3 to 6, 2017,the problems encountered by the primiparasuch as pain, physical and mental change, andanxiety, were recorded through direct care,body assessments, observations, conversations,and medical records. The primipara wasinstructed to wear an abdominal pressure beltand divert her attention to alleviate her pain.She was also instructed to self-observe foranomalous signs, thereby improving her selfcareconfidence. The primipara was encouragedto express her concerns about the hysterectomyto alleviate the negative emotions that sheexperienced regarding the changes in her body.The primipara was assisted in performingkangaroo care, holding her premature infant,and improving her caregiving skills to improvethe parent–child relationship and lessen heranxiety. During the care process, the authorfound there was no written education for breastmilk bank. Therefore, it is recommended thatwe need to establish a leaflet for breast milkbank for future patient needs.