一位產後出血行子宮全切除經產婦哺餵母乳之護理經驗

Nursing Experience of Assisting a Multipara in Breastfeeding After Total Hysterectomy for Postpartum Hemorrhage

陳子涵(Tzu-Han Chen) ； 謝保群(Pao-Chun Hsieh) ； 關祥彬(Hsiang-Pin Kuan)

《澄清醫護管理雜誌》 18卷2期 (2022/04) Pp. 84-92

摘要

本文探討一位42歲婦女自然產下一名女嬰，因產後大出血接受非預期性子宮全切除術之護理經驗。個案在無心理準備下緊急切除子宮，遭受身心巨大衝擊，另因相隔多年再度懷孕，在母乳哺餵上亦感受到挫折沮喪，影響其疾病調適，為其選案理由，照護期間2021年4月20日至2021年4月25日，運用觀察、會談、身體評估及病歷查閱等方式收集資料，依Gordon十一項健康功能性評估為指引，確立個案有術後傷口疼痛、身體心像改變及低效性母乳哺餵等健康問題。提供個別化的舒適護理，有效緩解術後傷口疼痛，減輕生理不適；運用圖片及單張，提供個案正確的子宮切除知識及給予良好的社會支持，讓個案能面對子宮切除的事實，持有正向生活調適之態度；在哺餵母乳方面，介入正確且具個別性的指導，增強個案於哺乳過程中正向的感受，提供支持性團體等資源，協助家庭成員共同參與母乳哺育，使之個案成功哺餵母乳。在面對緊急的產科急症，對於產婦治療處置告知的即時性受到限制，使產婦術後無預警地面對龐大的心理衝擊，故建議術後儘早提供正式的醫病會談，主動提供所有治療相關資訊，增進醫病溝通，以減緩產婦面臨之心理衝擊。

關鍵字

產後出血 ； 子宮全切除 ； 母乳哺餵

並列摘要

This paper discusses the nursing experience of a 42-year-old woman who gave birth to a female infant naturally and underwent an unscheduled hysterectomy due to postpartum hemorrhage. The patient underwent an emergency hysterectomy without psychological preparation and suffered a huge physical and mental impact. In addition, as she became pregnant again after many years, she also felt frustration in breastfeeding, affecting her adaptation to the disease. These are the reasons for selecting this research case. During the nursing period from April 20 - 25, 2021, data were collected by observation, interview, physical evaluation, review of medical records, etc. According to Gordon's 11 Functional Health Patterns Assessment, it was confirmed that the patient had health problems such as postoperative wound pain, body image changes, and ineffective breastfeeding. Individualized comfort care effectively relieved postoperative wound pain and physical discomfort. Pictures and leaflets were used to provide correct knowledge of hysterectomy and good social support for the patient to enable the patient to face the fact of hysterectomy and hold an attitude of positive life adaptations. Concerning breastfeeding, correct and individualized guidance was provided to enhance the positive feeling of the patient during breastfeeding, and resources such as support groups were provided to assist her family members to participate in breastfeeding to facilitate the patient's successful breastfeeding. In urgent obstetric emergencies, the immediacy of informing puerperae about the treatment and management is limited, making puerperae face a huge psychological impact without warning after the operation. Therefore, it is suggested to provide formal doctor-patient talks as soon as possible after operation, actively provide all relevant information on the treatment, and enhance communication between doctors and patients to mitigate the psychological impact faced by puerperae.

並列關鍵字

Postpartum hemorrhage ； Total hysterectomy ； Breastfeeding