照顧一位乳癌病人行腹直肌重建手術之護理經驗

Taking Care of a Breast Cancer Patient Undergoing Rectus Abdominis Reconstruction Surgery

本文描述一位37歲女性乳癌病人接受根除性乳房切除合併腹直肌重建手術之護理經驗。筆者發現個案除了術後傷口疼痛、更擔心乳房切除致身體外觀改變、手術過程及癒後結果，導致身心衝擊之焦慮情緒而引發探討動機，照護期間為2017年2月10日至2017年2月17日藉由直接、間接觀察法及傾聽、會談等方式收集資料，運用Gordon十一項功能性健康模式做整體性評估，確立個案有焦慮、急性疼痛、身體心像改變等護理問題。在照護過程中，給予個別性的護理措施，利用傾聽、同理心及衛教等方式，協助個案面對疾病，並接受治療，鼓勵個案說出對疾病的感受；利用手術前後護理衛教，提供疾病照護相關知識，教導術後居家傷口照護，幫助個案減輕焦慮，緩解其緊張情緒；疼痛程度則持續評估，教導轉移注意力方法緩解傷口疼痛，視情況給予止痛藥物，協助個案減輕生理上之不適。經護理措施之執行，成功的解決個案護理問題，使個案及家屬能共同面對疾病，順利渡過手術歷程，接受因疾病所造成的身體心像改變並學習自我照顧，幫助個案提升生活品質，早日回歸日常生活。期望藉由此護理經驗分享，提供臨床護理人員往後照護之參考。

This article describes a nursing experience of a 37-year-old female patient with breast cancer; she underwent radical mastectomy with rectus abdominis reconstruction. The writer finds that besides postoperative wound pain, the patient is worried about the changeable appearance, surgical process, and recovery after breast resection, which can result in physical and mental anxiety, so that there are still some motivations to discuss. This caring duration was from 10th to 17th February, 2017. By using direct and indirect observations, listening and interviewing to collect information, also through Gordon's Eleven Function Health Patterns to wholly evaluate, makes sure that the patient has anxiety, acute pain, and physical defect problems. In the process of taking care of patient, the writer provides individual nursing measures by listening, empathy, and health educations to assist the patient to face diseases and treatment; also courage the patient to talk about the feelings of diseases. In addition, the writer offers the knowledge about the caring of diseases and wounds, and help the patient release her anxiety and nerve by health educations before and after surgery. Last but not least, the writer teaches the patient to divert attention to relieve her pain, and keep evaluating the degree of pain and give painkillers appropriately to help the patient reduce physical discomfort. After the implementation of nursing measures, the writer successfully solves the problems, so that the patient and her family can face the disease and smoothly undergo surgical procedure together. Therefore, the patient can have a great courage to accept the physical defect caused by diseases and learn how to selfcare. Furthermore, improve the quality of life and return to daily life as soon as possible. By sharing this nursing experience, it will provide clinical nurses with valuable reference for the future.