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一位乳癌手術患者首次接受化學治療引起周邊神經病變之護理經驗
Nursing Care for a Breast Cancer Patient with Post-op Chemotherapy Induced Peripheral Neuropathy
Abstracts
本文敘述一位乳癌個案接受左乳部分乳房切除及植入人工血管，並於術後接受化學治療導致周邊神經病變之護理經驗。照護期間為：2018年12月12日至2018年12月21日，藉由訪視會談、傾聽觀察、查閱電子病歷及運用Gordon十一項項功能性健康評估，確立個案健康問題為：焦慮、急性疼痛及感覺與知覺紊亂。照護期間筆者透過關懷，與個案建立良好護病關係，藉由鼓勵個案說出內心感受並耐心傾聽，且針對其所提出疑問給予說明以減輕焦慮，並鼓勵家屬陪伴給予心理支持；教導固定引流管避免牽扯及翻身或活動時按壓傷口，避免肌肉牽扯，以棉被墊於患側肢體以及換藥時動作輕柔等方式降低疼痛；主動提供乳房切除及化學治療照護知識，衛教使用乳液及手套保護雙手以減少皮膚刺激，且穿著合身衣物及鞋子並保持光線充足及走道通暢、漸進式下床活動等方式以降低跌倒風險，並藉由給予冷療方式緩解化療引起之周邊神經病變等，期望經分享此護理經驗，提供護理同仁照護此類個案之參考，並建議於個案入院時提供跨團隊之全人醫療及醫病共享決策，讓個案與家屬能共同參與醫療決策以增進對於治療方式之了解。
Parallel abstracts
The article discusses the nursing experience of a breast cancer patient who suffered from the chemotherapy induced peripheral neuropathy after partial mastectomy of the left breast and Port-A insertion. From 12/12/2018 to 12/21/2018, through interviews, conversations, active listening, and consulting the medical records, the patient's health problems were identified on the Gordon 11 Function Health Patterns, which were anxiety, acute pain, and distorted sensation and perception. The author established a sound nurse-patient relationship by showing true concerns for the patient's feelings. Then the author was able to encourage the patient to speak up and to share the inner feelings by listening with patience; the author also gave patient instruction to reduce anxiety, and also encouraged the family to provide mental and emotional support. The patient was shown how to fix the drainage tube, press on the wound when moving, avoid muscular pulling, pad the affected side with quilts, and change dressing wound gently to reduce pain. Patient also learned more about mastectomy and chemotherapy, how to reduce skin irritation with lotion and gloves, wear the right kind of clothes and shoes, keep the rooms well-lit, get off the bed gradually to reduce the risk of fall, and control chemotherapy-induced peripheral neuropathy with cryotherapy. The author hopes to share this experience as a reference with the nursing colleagues for future guidelines. It's recommended that the Holistic Health Care and Share-Decision Making be introduced to the patients and family in order to reach a joint medical decision through a better understanding of the disease and the treatment.
References
Read-around
- 許莉宛、林美娟（2011）。照護一位乳癌術後病患定期住院接受化學治療之護理經驗。安泰醫護雜誌，17(3)，27-38。https://doi.org/10.7078/TSMHMNJN.201109.0029
- 阮瓊慧（2010）。乳癌術後輔助性化學治療病人之症狀群集〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://doi.org/10.6832/KMU.2010.00061
- 連金延、陳淑慧、蔡佩嬪、陳康敏、謝雅宜、梁穎（2010）。首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮及自我照顧之成效探討。護理雜誌，57(6)，51-60。https://doi.org/10.6224/JN.57.6.51
- 許瓊惠、王維芳（2013）。一位合併惡性蕈狀傷口的乳癌病人接受門診放射治療期間之護理經驗。長庚護理，24(1)，62-70。https://doi.org/10.6386/CGN.201303_24(1).0007
- 陳曉慧、林佩昭（2018）。Nursing Care for Advanced Breast Cancer Female Patient with Fungating Wound Pain。腫瘤護理雜誌，18(2)，47-57。https://doi.org/10.6880/TJON.201812_18(2).05