照顧一位乳腺炎雙胞胎產婦成功哺餵母乳之護理經驗

The Nursing Experiences of Taking Care of a Mother of Twins Who Experienced Mastitis and Breastfed Successfully

10.6386/CGN.201906_30(2).0010

吳思靜(Sih-Jing Wu)；彭月珠(Yueh-Chu Peng)

雙胞胎 ； 乳腺炎 ； 脹奶 ； 母乳哺餵 ； twin ； mastitis ； breast swelling ； breastfeeding

長庚護理

30卷2期（2019 / 06 / 01）

241 - 251

繁體中文

本篇報告為描述一位乳腺炎雙胞胎個案成功哺餵母乳之護理經驗。護理期間由2017年7月17日至2017年7月21日止，筆者運用Gordon十一項健康功能型態作為評估架構，進行生理、心理及社會層面之健康功能型態的資料收集及分析，確立個案有急性疼痛、焦慮、知識缺失、潛在危險性感染等護理問題。護理過程中，藉了解個案喜好，營造舒服及安全的環境，增進個案舒適度，在急性疼痛時，搭配藥物使用，教導轉移注意力及有效移出乳汁的方法，並協助刮痧，以減輕疼痛；藉著主動關懷與個案建立良好的護病關係，予傾聽、支持個案內心感受，針對疾病有疑慮處，協助聯絡醫師，提供諮詢管道，澄清疑惑以面對問題，並教導可尋求之資源，使個案能減少焦慮並以較正向的態度面對乳腺炎；也提供返家後預防乳腺炎再次發生注意事項，以提升其返家後的生活品質。照護過程中，深感病房針對產後婦女，常規會提供脹奶之衛教單張，但卻無針對乳腺炎的書面衛教，故建議病房能建立乳腺炎標準化之衛教手冊，提供病人及家屬更進一步的認識乳腺炎發生原因及其返家後照護注意事項，減少其發生及再發生率。

This case report described the nursing experience of caring a mother of twin who experienced mastitis and breastfed successfully. The caring period was from July 17 to July 21, 2017. Data which included physiological, psychological, and social dimensions were collected and analyzed by the assessment tool of Gordon's 11 health functions model. Four main domains of health problems were determined: acute pain, anxiety, deficient knowledge, and risk for infection. To alleviate acute pain, the author provided a comfortable and secure environment, used analgesics, distracted attention, effectively removed breast milk, and scraped. To reduce patient's anxiety, the author established good relationships with the patient to listen to her inner feelings. To increase mastitis knowledge, the author also provided points for attention for preventing mastitis recurrence to improve the quality of life after returning home. During the care process, the author found that written education material for mastitis was lacking. Therefore, it is recommended that a pamphlet for mastitis care should be created and provide it to patients and their family members to reduce the occurrence and recurrence.

1. Chiu, J. Y.,Gau, M. L.,Kuo, S. Y.,Chang, Y. H.,Kuo, S. C.,Tu, H. C.(2010).Effects of Gua-Sha therapy on breast engorgement: A randomized controlled trial.The Journal of Nursing Research,18(1),1-10.
   連結：
2. Berens, P. D.(2015).Breast pain: Engorgement, nipple pain, and mastitis.Clinical Obstetrics and Gynecology,58(4),902-914.
3. Guidelines and Audit Implementation Network. (2009). Guidelines on the treatment, management & prevention of mastitis. Retrieved from http://www.gain-ni.org
4. Iravani, M.,Zarean, E.,Janghorbani, M.,Bahrami, M.(2015).Women's needs and expectations during normal labor and delivery.Journal of Education and Health Promotion,4(6)
5. Kurth, E.,Krähenbühl, K.,Eicher, M.,Rodmann, S.,Fölmli, L.,Conzelmann, C.,Zemp, E.(2016).Safe start at home: What parents of newborns need after early discharge from hospital - a focus group study.BMC Health Services Research,16(82)
6. Noonan, M.(2010).Lactational mastitis: Recognition and breastfeeding support.British Journal of Midwifery,18(8),503-508.
7. Ojelade, O. A.,Titiloye, M. A.,Bohren, M. A.,Olutayo, A. O.,Olalere, A. A.,Akintan, A.,Fawole, B.(2017).The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study.International Journal of Gyneology & Obstetrics,139(Suppl. 1),27-37.
8. Summers, A.(2011).Managing mastitis in the emergency department: Anthony Summers discusses the causes, incidence, symptoms and treatment of this common but painful problem in women who breastfeed infants.Emergency Nurse,19(6),22-25.
9. 江宛蓉(2011)。哺乳期乳腺炎。中醫藥研究論叢，14(1)，108-115。
10. 李鳳雪、莊秋萍、陳淑芬(2011)。實證探討應用高麗菜葉對於哺乳婦女乳房充盈腫脹之改善。榮總護理，28(2)，111-116。
11. 林佩蓁(2013)。產婦乳腺炎的預防護理及中醫治療。中醫婦科醫學雜誌，17，28-32。
12. 劉蕙蜜、陳威志、林麗珠、歐香縫、陳淑齡(2013)。不同姿位乳房護理對產後婦女乳房腫脹成效評估。榮總護理，30(3)，237-245。
13. 衛生福利部國民健康署(2014)‧多胞胎寶寶的母乳哺育須知‧取自 http://mammy.hpa.gov.tw/Home/NewsKBContent?id=406&type=01[Health Promotion Administration, Ministry of Health and Welfare. (2014). Breastfeeding tips for multiple babies. Retrieved from http://mammy.hpa.gov.tw/Home/NewsKBContent?id=406&type= 01]
14. 衛生福利部國民健康署(2018)。母乳哺育手冊。
15. 顏兆熊(2008)。乳腺炎。當代醫學，415，364-368。
16. 蘇莉婷、張富勝、李育慶(2017)。乳腺炎與母乳哺育。家庭醫學與基層醫療，32(9)，257-263。