一位初次乳癌接受改良性乳房手術獨居長者之護理經驗

Nursing Experience of a Single Senior Person with Breast Cancer for the First-Time Receiving Modified Radical Mastectomy

10.29494/LN.202212_23(4).0008

許雯涵(Wen-Han Hsu)；林芊玉(Chien-Yu Lin)；林麗卿(Li-Ching Lin)；鄭素月(Sue-Yueh Cheng)

乳癌 ； 改良性乳房根除手術 ； breast cancer ； modified radical mastectomy

領導護理

23卷4期（2022 / 12 / 01）

115 - 130

繁體中文

本報告主旨在描述一位初次罹患乳癌的獨居長者接受改良性乳房根除手術之護理經驗。護理期間2019年3月19日至3月26日，運用Gordon十一項健康功能型態為評估架構，並以身體評估、觀察、會談及直接照護等方式完成相關資料的收集。經評估分析後，確立個案主要健康問題有：急性疼痛、潛在危險性感染、身體心像紊亂。針對個案健康問題給予個別性之照護計畫，藉由與個案建立良好護病關係後，教導固定傷口、減輕疼痛技巧，使個案傷口疼痛強度降低；保持傷口乾燥、嚴格遵守無菌技術，順利拔除傷口引流管、拆線；與物理治療師討論，依個案年齡、病況，修改乳癌術後患臂復健運動計劃，進行活動時，在旁耐心的陪伴，如達目標時，給予鼓勵、讚美。並引導表達自我感受，教導放鬆技巧，並鼓勵個案重拾過去有效緩解壓力的繪畫，減輕身體心像紊亂及焦慮；並建議出院後申請居家照服員，每日到府協助日常家務事宜。並藉此護理經驗提供日後照護獨居年長病人之同仁參考。

This report aims to describe the experience of providing nursing care to an elderly patient who lived alone, was diagnosed with breast cancer for the first time, and had undergone modified radical mastectomy. The care was provided between March 19th and 26th, 2019, and Gordon's Eleven Functional Health Patterns were employed as the assessment framework. Data were collected through physical assessment, observation, interviews, and direct care. After assessments and analyses, the author established the patient's main health conditions include: acute pain, potential risk of infection, body image disturbance, and anxiety. In response to these health conditions, the author developed a customized care plan for the patient. By building a fine nurse-patient relationship, the author teach the patient wound fixation and pain relief techniques to reduce the intensity of wound pain; keep the wound dry, strictly abide by aseptic techniques, and smoothly remove the wound drainage tube and remove sutures. The author consulted the physiotherapist to develop a post mastectomy arm rehabilitation plan according to the patient's age and conditions. The author patiently accompanies the patient throughout the rehabilitation activities and provided encouragement and praise when the patient reached the targets of rehabilitation. The patient was guided to express her feelings, taught relaxation skills, and encouraged to resume painting that the patient had found stress-relieving in the past, so as to alleviate body image disturbance and anxiety. The patient was recommended to apply, through the Department of Social Welfare for a home care attendant after discharge from the hospital that will assist her with daily housework. The nursing care experience could serve as a reference when caring for elderly patients living alone in the future.

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