中年未婚乳癌病患面對全乳房切除手術之護理經驗

Experience of Nursing Care of an Unmarried Middleaged Woman Who Underwent Surgery for Breast Cancer

徐瑞貞(Jui-Chen Hsu)

《榮總護理》 33卷1期 (2016/03) Pp. 100-107

https://doi.org/10.6142/VGHN.33.1.100

摘要

乳癌為台灣婦女發生率最高的癌症，其中第二期乳癌合併腋下淋巴轉移患者，大部分施行全乳房切除手術，並接受輔助性化學藥物治療，故病患勢必面臨治療過程中之身心變化與壓力。本文主要探討一位中年未婚女性面對左乳房全切除之住院期間，重建身體、心理和社會功能之護理經驗。護理期間自2013年5月21日至5月30日，運用Gordon十一項健康功能評估分析後，確立個案有身體活動功能障礙、身體心像改變、焦慮等護理問題。個案原為社區營造工作人員，突然被診斷罹癌與手術，不僅改變外觀，更頓時失去經濟獨立自主狀態，故護理期間針對其心理與身體問題，特別邀請已成功完成治療的個案親身分享，並與個案同住的家庭成員會談以建立良好的支持系統，緩解其焦慮與沮喪情緒；手術造成的身體心像改變及肩部活動功能障礙，藉由衣著指導、手臂復健運動配搭音樂治療，協助個案以正向態度接受治療，克服手術後與治療中所帶來的壓力與衝擊，進而維護返家後生活品質，筆者藉此護理經驗提供護理人員日後照護此類個案之參考。

關鍵字

乳癌 ； 焦慮 ； 身體心像改變 ； 中年未婚乳癌病患

並列摘要

Breast cancer is the leading cause of female malignancy in Taiwan. Stage II breast cancer with axillary lymph node metastasis is currently treated with mastectomy and adjuvant chemotherapy. The physical and psychological stress during the course of treatment is tremendous. This paper discusses the nursing care experience for an unmarried middle-aged woman who received left breast mastectomy and reconstruction surgery. The physical, psychological, and social functions during hospitalization were evaluated using Gordon's 11 Functional Health Patterns Assessment to determine physical activity dysfunction, changes in body image, anxiety, and other care issues. The case was a community building worker. The unexpected ailment and surgery altered her appearance and deprived her of economic independence. We invited other cases who had successfully completed treatment of a similar condition to share their psychological and physical problems. Detailed discussion with family members established an effective support system in order to relieve her anxiety and frustration. Postoperative body image changes and dysfunction of the shoulder were managed with guidance dresses and rhythmic arm rehabilitation sports. We encouraged her to maintain a positive attitude and overcome the stress and impact of the disease and treatment, thereby maintaining her quality of life after returning home. We report this care experience for future reference of such cases.

並列關鍵字

breast cancer ； anxiety ； body image change ； unmarried middle-aged breast cancer patients

參考文獻

方素瓔、邱幸嬋、徐畢卿(2008)．以物化論看乳癌婦女切除乳房後的身體經驗．護理雜誌， 58(4)，75-80。

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。

郭鳳霞、張雅嵐、林碧珠(2008)．協助乳癌病人面對初次化療過程之護理經驗．榮總護理，25(2)，161-166。

淑妙(2011)．協助一位乳癌根除術後疾病緩解期婦女經歷乳房重建之照護經驗．嘉基護理，11 (2)，35-45。

秀如、余玉眉(2007)．體現與身體心像．護理雜誌，54(3)，77-80。