照顧一位子宮內膜癌未婚女性行子宮卵巢切除術後之護理經驗

The Nursing Experience of Caring for a Unmarried Woman Abdominal Total Hysterectomy Bilateral Salpingo-Oophrectomy with Endometrial Cancer

古雪貞(Hsueh-Chen Ku) ； 李珮禎(Pei-Chen Li) ； 田聖芳(Sheng-Fang Tien)

《腫瘤護理雜誌》 10卷1期 (2010/06) Pp. 75-86

https://doi.org/10.6880/TJON.201006_10(1).07

摘要

罹患癌症對病人及整個家庭都有莫大的衝擊。本篇個案報告主要探討一位37歲未婚未曾生育過之女性本因單純子宮肌瘤入院手術，術後卻於出院日得知病理報告診斷為罹患子宮內膜癌，因而再度入院進行癌症分期手術，並面臨生理、心理的衝擊及調適的掙扎。在2008年8月10日至8月18日的護理期間，筆者藉由Gordon十一項健康功能評估，經過會談、觀察及直接照護等方式所收集之資料來進行完整性的評估。發現個案住院期間主要的護理問題有：一、焦慮－無法掌握子宮內膜癌的相關知識及對其手術的危險性和結果並不確定；二、急性疼痛：與手術後腹部傷口有關；三、身體心像紊亂：與切除子宮及雙側卵巢有關。在護理期間，除提供合宜生理照護及促進其舒適外，主動積極陪伴與傾聽以建立信任和支持的關係；提供正確護理指導；誘導個案主動說出內心的感受；導引其朝向積極的思維，同時鼓勵家人的參與和支持，以協助個案達到生理和心理健康的調適。希望藉此經驗分享，提供護理人員未來照顧此類個案之參考。

關鍵字

子宮內膜癌 ； 未婚女性 ； 子宮卵巢切除手術 ； 護理經驗

並列摘要

Cancer may cause a great impact on patients and family. The aim of this report is to discuss the postoperative nursing experience of caring for a 37 year-old woman who had undergone myomectomy and later received a pathology report indicating endometrial cancer on the day of discharge. She was re-admitted for staging operation, forced to face the physiological and psychological impact. The nursing period started from August 10 to August 18, 2008. By using Gorden's 11 functional health assessment via conversation, observation, and nursing care, we gathered information to perform a complete assessment which discovered several problems of the subject during her hospital course: 1. Anxiety-in association with lack of information on the disease and the uncertainty of the operational risk and prognosis, 2. Acute pain-in association with surgical wound, and 3. Body image disturbance-in association with hysterectomy and bilateral oophorectomy. During this period of nursing care, not only did we provide appropriate physiological assistance and comfort, we also built up trust and give support by accompanying and listening attentively to the client. We had shown empathy by comprehending the client's feeling toward the disease. We had guided the client in positive thinking and encouraged family involvement and support to achieve both physiological and psychological healthiness. By sharing the above experience, I hope it can provide a useful resource for the nursing staff on future nursing care.

並列關鍵字

endometrial cancer ； unmarried woman ； abdominal total hysterectomy bilateral salpingo-oophrectomy ； nursing experience