- 期刊
照顧一位男性乳管原位癌接受乳房全切除之手術全期護理
Full-time Nursing Care of a Male Patient with Breast Ductal Carcinoma in Situ Underwent Total Mastectomy
摘要
本文是一位78歲男性罹患乳管原位癌接受乳房全切除之手術全期護理。護理期間於2017年1月9日至1月12日藉由病歷查閱、病房訪視、身體評估、實際照顧、會談、電腦查詢等方式，並運用Gordon十一項功能性健康型態為架構方式收集資料，確立個案健康問題有手術前期焦慮，手術中期潛在危險性傷害，手術後期急性疼痛等。在護理期間進行術前訪視，得知個案曾以中醫求治造成延誤處置，故手術前訪視澄清個案錯誤觀念，並衛教正確疾病就醫處置，此外提供乳管原位癌預後治癒率可達90%，讓個案放心進而降低焦慮。手術中期協助將患側手臂放置加墊臂拖板，避免臂神經叢及尺神經受損，雙膝下及足跟處放置枕頭及棉被預防垂足，手術採仰臥位，手臂至於身體兩側，保持掌面朝上，溫毯上需放置布單，避免與個案皮膚直接接觸，手術結束後無神經、皮膚損傷發生。手術後期利用視覺等級量表來評估疼痛程度，並依據不同的疼痛指數，給予不同的止痛方式減緩疼痛。藉由此特殊個案手術全期照護經驗提供日後護理人員照護之參考。
並列摘要
This article reported a 78-year-old man with breast ductal carcinoma in situ (DCIS) underwent a total mastectomy. From January 9th to January 12th, 2017, we collected information through medical records review, ward visits, physical assessment, actual care, interviews, computer inquiries, with Gordon 11 Function Health Patterns. The patient had preoperative anxiety, a potential risk of injury in the middle stage of surgery, and acute pain in the later stages of surgery. The preoperative visits helped the case clarify the misconceptions of the disease, and gave health education to have the correct concept for receiving medical treatment. In addition, the case was informed that the DCIS prognosis rate was up to 90%. This information let the case rest assured and reduced anxiety. In the middle stage of the operation, the affected arm was padded with the arm plate to avoid damage to the brachial plexus and ulnar nerve. Pillows and quilts were placed under the knees and heels to prevent the foot from falling. The body was placed in the supine position, and the arms were on both sides of the body to keep the palm face up. The warm blanket was placed on a sheet of cloth to avoid direct contact with the skin. Therefore, no nerve or skin damage occurred after surgery. At the end of the operation, pain relief methods were used to relieve pain by the visual rating scale assessment. This full-time care experience will provide a reference to the care of the similar case by future caregivers.
參考文獻
延伸閱讀
- 陳秀月、沈麗盆（2011）。一位乳癌病人行乳房切除及重建手術之護理經驗。高雄護理雜誌，28(1)，47-58。https://doi.org/10.6692/KJN-2011-28-1-5
- 吳淑貞、陳文文、劉雪娥（2002）。照顧一位乳癌術後行立即性重建患者之護理經驗。志為護理-慈濟護理雜誌，1(4)，99-105。https://doi.org/10.6974/TCNJ.200212.0099
- 陳明婉、宋聖芬、江郁芬（2014）。照護初診斷乳癌行全乳根除併立即性自體組織重建病人之護理經驗。馬偕護理雜誌，8(2)，73-84。https://doi.org/10.29415/JMKN.201407_8(2).0007
- 鄭采宸（2011）。照顧一位乳癌患者術後行立即性乳房重建之護理經驗。彰化護理，18(1)，32-41。https://doi.org/10.6647/CN.18.01.11
- 林惠嫻、梁天麗（2008）。Nursing Care Experience of a Female Patient With Breast Cancer Combined Malignant Wound and Body Image Disturbance。弘光學報，(53)，67-81。https://doi.org/10.6615/HAR.200808.53.06