照護一位乳癌術後合併身體心像紊亂之護理經驗

Nursing experience of caring for a patient with postoperative breast cancer combined with disturbance of body image

本篇描述一位65歲女性初次罹患乳癌接受右側乳房改良式根治及淋巴清除術，術後身體外觀巨大變化心理面臨衝擊之護理經驗。照護期間2018年10月22日至11月2日，以羅氏適應模式為評估架構，利用觀察、溝通、會談技巧及查閱病歷等方式進行收集資料，照護期間與個案建立良好護病關係，發現個案三項健康問題：潛在危險性感染、乳房切除術後復健運動知識不足，以及身體心像紊亂等健康問題。針對個案健康問題給予個別性護理措施，協助與指導家屬傷口無菌換藥，維持血糖重要性，避免術後併發症；術後乳癌復健運動，預防淋巴水腫形成，增加肩部活動度；個案失去右側乳房的心靈困境，藉由不斷關懷及陪伴，鼓勵表達內心感受，運用認知行為療法和乳癌病友團體交流經歷、穿戴義乳與裝扮經驗分享，建議個案利用棉花製作仿真乳房造型，達到正向外觀調適。期望藉此護理經驗能提供臨床護理同仁照護此類個案之參酌。

Nursing experience of caring for a patient with postoperative breast cancer combined with disturbance of body image This article describes the nursing experience of a 65-year-old woman suffering from breast cancer for the first time undergoing modified radical mastectomy and lymphadenectomy on the right side of the breast. After the surgery, her body appearance has undergone tremendous changes and her mentality has been impacted. During the care period from October 22 to November 2, 2018, the Roche adaptation model was used as the assessment framework, and data were collected using observation, communication, interview skills, and medical records review. During the care period, a good care-patient relationship was established with the case and the case was discovered. Three health problems: potentially dangerous infections, insufficient knowledge of rehabilitation exercises after mastectomy, and health problems such as disorders of body and mind. Provide individual nursing measures for the case´s health problems, assist and guide the family members´ wounds in sterile dressing change, maintain the importance of blood sugar, and avoid postoperative complications; Postoperative breast cancer rehabilitation exercises to prevent the formation of lymphedema and increase shoulder mobility; The mental dilemma of the case losing the right breast. Through continuous care and companionship, encourage expressing inner feelings, use cognitive behavioral therapy and breast cancer patient groups to exchange experiences, wear prosthetic breasts and dress up experience sharing. It is recommended that the case use cotton to make simulated breasts to achieve positive Adjust to the appearance. It is hoped that this nursing experience can provide clinical nursing colleagues with consideration for caring for such cases.