- 期刊
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
The Nursing Experience of a Breast Reconstruction Female with Breast Cancer in Remission Stage Post Modified Radical Mastectomy
摘要
本文敘述一位40歲接受改良式乳房根除術後之乳癌婦女因身體心像紊亂近四年，入院進行自體腹直肌皮瓣乳房重建手術之護理經驗。在2008年7月9至16日護理期間，藉由主動關懷、觀察、病歷和會談紀錄收集個案資料，確立其健康問題包含身體心像改變、術後皮膚完整性受損以及缺乏乳房重建相關照顧知識。我們提供良好的術後傷口照護及滿足個案生理需求以促進傷口復原過程，建立良好護病關係後，使用圖片、個案傷口癒合中照片配合相關衛教資訊，引導個案表達自己對身體心像和右乳與重建後左乳的感受；鼓勵接受家人給予的支持與肯定自己的價值，同時教導重建後的乳房組織自我照顧方法，逐步建立對自我正向身體心像與信心。介紹相關支持團體並轉介個案管理師，共同討論出院後的社會再適應和提供諮詢管道與後續自我照顧相關資訊。個案得以於術後第七天順利出院。分享此護理經驗，作為護理同儕照顧此類個案的參酌，期望護理人員重視病人心理感受、掌握乳房重建過程照護要項並滿足個案持續照顧之需求。
並列摘要
This article describes the nursing experience of a forty-year-old female with breast cancer suffered body image disturbance nearly 4 years after modified radical mastectomy, admitted for receiving transverse rectus abdominis myocutaneous flap(TRAM) surgery for her breast reconstruction. During care period, July 9th to 16th, 2008, we collected the case data through active caring, observation, medical reports and interview records. Her health problems included disturbed body image, impaired skin integrity post TRAM surgery, lack of self-care knowledge and related issues information about breast of breast reconstruction and related knowledge. We provided good wound care and satisfied her physical needs in order to improve the healing process after the operation. While building up good nurse-patient relationship, induced the case expressing her feelings about disturbed body image and after comparing right breast and reconstructed left breast by using picture, her healing wound and reconstructed breast photograph, and related education materials for teaching self-care knowledge. Encouraging the case to receipt families' caring and consider herself deserve to be the reward. In addition, build up her positive body image gradually and confidence by teaching self-care of reconstructed breast. Moreover, we consulted case manager and discussed her discharge plan, introduced self-help groups as her support system after discharge our ward. The case could return home smoothly on the seventh day after TRAM surgery. Sharing the nursing experience as a reference for peer nursing staff, expecting nurses could devote their attention to such similar patients' inner feelings, lay great stress on nursing care of helping breast reconstruction process and fulfill those patients' self-care requirement for continuous care.