照護一位乳癌患者合併妊娠後期之護理經驗

Nursing Care for a Breast Cancer during the Late Pregnancy

紀雯眞(Wen-Chen Chi) ； 廖珍娟(Jen-Jiuan Liaw) ； 姚鍾太(Chung-Tay Yao) ； 周繡玲(Hsiu-Ling Chou)

《腫瘤護理雜誌》 6卷2期 (2006/12) Pp. 53-64

https://doi.org/10.6880/TJON.200612_6(2).06

摘要

本個案報告的目的即在探討一位乳癌患者於妊娠後期階段，因胎兒長大及癌細胞轉移至肺部，導致呼吸喘的現象，需使用化學藥物來減緩個案呼吸喘的問題，醫護人員在面臨此情境時除考量個案本身的健康，還憂心懷孕期間的化學治療對胎兒的傷害。照顧期間爲2006年5月24日至7月12日，筆者藉由直接照顧、觀察、會談、傾聽與家人互動，並運用Gordon十一項健康功能型態來評估個案身、心、靈等層面之問題，確立個案主要的護理問題爲：低效性呼吸型態、營養不均衡：少於身體所需與焦慮。於照護過程中配合化學治療處置及著重於改善個案呼吸喘的護理措施，並會診營養師規劃孕期營養來確保懷孕後期胎兒的成長；再藉由多科醫護團隊人員，密切監測個案身體狀況外，並給予正向鼓勵及清楚說明會定時使用胎兒監視器密切評估胎兒於母腹中的狀況，另透過關懷及陪伴個案度過妊娠後期直至剖腹順利將胎兒產下，來減輕個案焦慮的情緒。期待此特別的護理經驗能提供腫瘤護理人員思考化學藥物對孕婦的影響及重視照顧此類病患身、心、靈各方面安適之議題。

關鍵字

乳癌 ； 妊娠後期 ； 化學治療 ； 護理經驗

並列摘要

This article is to describe a prospective mother with breast cancer who suffered dyspnea due to the fetus growth and the lung metastasis of the cancer cells in the late pregnancy. It is a challenge for health care providers for relieving patient's dyspnea by employing chemotherapy that may affect the woman's health during pregnancy, and may cause damage to the fetus. We took care of this pregnant woman from May 24 to July 12 in 2006, and identified her physical, psychological and spiritual deterioration. The data were collected and assessed through Gordon's eleven function health patterns, observations, interview, listening and interaction with her family. The patient's problems were recognized as the follows: (1) Ineffective Breathing Pattern; (2) Imbalanced Nutrition: Less Than Body Requirement; (3) Anxiety. In the course of chemotherapy, nursing interventions were focused on reducing dyspnea, and maintaining the appropriate diets for fetus growth during the pregnancy. The multidisciplinary health work team monitored carefully the patient's physical condition, provided positive supports, and clearly explained to the patient the methods of fetal monitoring during the pregnancy and delivery. To ensure the patient's confidence, we gave comprehensive caring and fetal monitor that supported the mother during the pregnancy until the fetus was delivered. We expect that the special nursing experiences could facilitate nurses in the oncological units to consider the effects of chemotherapy on pregnant women, and provide physical, psychological and spiritual care for these patients.

並列關鍵字

breast cancer ； late pregnancy ； chemotherapy ； nursing care