照顧一位經腹部子宮全切除患者之手術全期護理經驗

Perioperative Care of a Patient with Cervical Cancer Undergoing Total Abdominal Hysterectomy

柯淑嫺(Shian-Shu Ke) ； 蔡瑞琪(Ruei-Ci Cai)

《馬偕護理雜誌》 3卷2期 (2009/07) Pp. 68-76

https://doi.org/10.29415/JMKN.200907_3(2).0007

摘要

本文乃描述一位三十七歲，罹患子宮頸癌住院接受經腹部子宮全切除手術病患之護理經驗，筆者以手術全期護理師角色，於2008年1月16日至1月21日護理期間於個案手術前、中、後之護理過程中，藉由訪視、觀察、會談等方式收集資料，並運用身體、情緒、智能、社會、靈性五大層面進行整體性護理評估，確認個案有：一、焦慮，與前次手術不好的經驗及害怕發生生命危險有關；二、潛在危險性傷害，與皮膚損傷、長時間維持仰臥式固定不動及使用電燒器容易造成電燒傷、異物殘留危險有關；三、急性疼痛，與手術傷口有關等健康問題。在護理過程中，筆者針對個案需求予以個別性及連續性之護理計畫與措施、適切性的衛教、術前的訪視、解說手術過程、澄清個案疑慮等，予提供正確的知識，建立其信心，協助緩解患者傷口疼痛等，以協助解決其手術前、中、後所面臨的健康問題；並於出院返家後持續以電話訪談，追蹤病人返家後身體恢復狀況，協助個案得以順利渡過此次住院期間整個治療過程。

關鍵字

子宮頸癌 ； 子宮全切除術 ； 手術全期護理

並列摘要

From January 16 to 21, 2008, the author cared for a 37-year-old woman with who underwent total abdominal hysterectomy for cervical cancer. Pre-, peri-, and postoperative data was collected by interview, observation, and listening to the patient, as well as review of the case history before surgery and visits and telephone follow up afterwards. The five aspects of overall nursing assessment and overall nursing model of operation were used to assess the patient. The nursing problems included: (1) preoperative anxiety, (2) the usual risks of harm during surgery, and (3) postoperative pain and wound care. Professional communication skills allowed the author to recognize the patient's issues and instill confidence. Identification with and understanding of the patient's situation, feelings, and motives helped decrease her anxiety and agitation. Comfort care postoperatively included adequate pain management and helping the patient to increase her ability of care for herself. After she was discharged home, telephone follow-up allowed assessment of her recovery and personal encouragement.

並列關鍵字

cervical cancer ； hysterectomy ； overall nursing of surgery