照顧一位植入性胎盤且次子宮全切除初產婦之護理經驗

懷孕是段充滿未知的旅程，若此時發現植入性胎盤且有早產脅迫，孕婦得面對大量出血，可能子宮必須全切除，導致生育能力喪失的威脅外，若處理不當，甚且可能危急自身的生命，最後，還得擔憂早產寶寶，發育不成熟，其後可能的健康問題等，都讓產婦身心飽受煎熬，故引發筆者探討動機。本文運用羅氏理論，探討一位穿透性植入性胎盤，於36週早產，且須接受次子宮全切除初產婦的照護過程，於2017年2月3日至2017年2月6日，透過直接照護、身體評估、觀察、會談及病歷查閱等方式收集資料，確立個案護理問題有疼痛、身體心像改變、焦慮等。透過教導正確使用束腹帶與轉移注意力的方法，以減輕疼痛；衛教自我觀察異常徵象的能力，提高自我照顧的自信心，並鼓勵說出對子宮切除的擔心，以抒發其對身體心像改變之負向情緒；並協助執行袋鼠式護理、鼓勵個案觸摸早產兒及提供早產兒照護技巧等增加親子依附關係，以減輕焦慮。照護過程中，有鑒於病房缺乏有關母乳庫的衛教單張，建議病房可制定有關母乳庫之衛教單張，以供未來病人需要時取用。

關鍵字

植入性胎盤；子宮切除；初產婦；早產；身體心像改變

並列摘要

Pregnancy is a life experience characterized by uncertainty. Pregnant women with placenta accreta who are at risk of pre-mature delivery may face severe hemorrhage. Their uteri may need to be fully removed, costing them their fertility. If their conditions are improperly managed, their lives may be at risk. In addition, because their premature infants are not completely developed, the infants may face subsequent health problems, creating a psychological burden on the mothers. This paper describes the nursing care provided to a primipara with placenta accreta who delivered prematurely at 36 weeks and who had to undergo subtotal hysterectomy through Roy's adaptation model. From February 3 to 6, 2017, the problems encountered by the primipara such as pain, physical and mental change, and anxiety, were recorded through direct care, body assessments, observations, conversations, and medical records. The primipara was instructed to wear an abdominal pressure belt and divert her attention to alleviate her pain. She was also instructed to self-observe for anomalous signs, thereby improving her self-care confidence. The primipara was encouraged to express her concerns about the hysterectomy to alleviate the negative emotions that she experienced regarding the changes in her body. The primipara was assisted in performing kangaroo care, holding her premature infant, and improving her caregiving skills to improve the parent-child relationship and lessen her anxiety. During the care process, the author found there was no written education for breast milk bank. Therefore, it is recommended that we need to establish a leaflet for breast milk bank for future patient needs.

並列關鍵字

placenta accrete ； hysterectomy ； primipara ； preterm labor ； body image disturbance

參考文獻

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照顧一位植入性胎盤且次子宮全切除初產婦之護理經驗

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