一位乳癌患者接受乳房根除合併腹直肌皮瓣轉移重建之手術全期護理經驗

The Perioperative Nursing Experience of a Breast Cancer Patient who Underwent Mastectomy with TRAM Flap Reconstruction

10.29442/HPRP.202107_4(2).0005

周惠玲(Hui-Ling Chou)；李旻燕(Min-Yen Lee)

改良性乳房根除術 ； 橫向腹直肌皮瓣（腹直肌皮瓣轉移） ； 手術全期護理 ； Modified radical mastectomy ； Pedicled transverse rectus abdominals myocutaneous ； Perioperative nursing care

健康促進研究與實務

4卷2期（2021 / 07 / 01）

33 - 44

繁體中文

目的：運用手術全期護理照護模式，協助乳癌患者面臨乳房切除的自卑、乳房重建對身體外觀改變的衝擊及擔心影響夫妻情感而失去自信的個案，勇敢面對手術，重建正向的身體心像，早日回歸日常生活。方法：2018年5月6日至5月13日護理期間，運用Gordon 11項健康功能型態評估，確立個案有焦慮、潛在危險性手術情境傷害、急性疼痛及身體心像紊亂之健康問題，於術前以關懷接納的態度，引導個案表達對疾病、手術重建的焦慮與感受，藉由情緒分享、傾聽給予正向的心理支持，提供疾病與手術的相關訊息，增加對病程發展的認知；術中以專業知識及技術，預防潛在危險性手術情境傷害；術後疼痛教導非藥物輔助治療之轉移注意力、局部按摩等柔和技巧緩解疼痛，乳房重建對身體心像改變所帶來的衝擊，提供醫護團隊資源、協同社工師討論支持團體資訊及親情的心靈支持與陪伴，修正負向情緒，恢復正向的身體心像。結果：術前個案表能達心中感受，抒發焦慮不安的情緒，勇敢接受手術治療；術中以專業知識及技術，無潛在危險性手術情境傷害；術後面對乳房重建能表達自我感受，並主動參與社交活動，並以正向的思考重建信心與自我價值的肯定。結論：專業的照護團隊提供疾病、手術、乳房重建及返家後的相關照護資訊，使個案能獲得身、心、靈、社會等全面性的照顧，以落實病人為中心之手術全期護理。

Objectives: Using perioperative nursing care as base to assist a patient who facing low self-esteem and the impaction on mastectomy surgery which change the appearance with the reconstruction. At the same time, she was also loosed self-confidence for worried about the relationship of couple's. By means of the nursing model, we could support the patient to face the operation bravely and rebuild body image in positive way and return to daily life as soon as possible. Method: This period of nursing care was performed from 6^(th) to 13^(th) May, 2018. Through the guideline of Gordon's Eleven Function Health Patterns, we evaluated and confirmed that the patient had anxiety, potentially risk of operation related injury, acute pain, and body image disturbance. Before the operation, we conduct the patient with caring and acceptance to make patient express the anxiety about the disease and surgical reconstruction. Besides, the author provided psychological support through sharing and listening and to offer the information about the disease and surgery to the patient. During the operation, the author prevented potentially risk of operation related injury under professional knowledge and technology. Postoperatively, the author taught the patients to divert attention and massage to relieve her pain and cope with the impaction on change of body appearance. In addition, medical team resources are provided and the social workers joined in discussing information as support groups. Furthermore, family support and companionship allow the patient to restore her body image positively. Results: Before underwent the surgery, the patient was able to express her feelings, anxiety and to face the surgery bravely. The patient suffered free from potentially risk of operation and the patient can express her feelings after the operation, to participate in social activities and to rebuild self-confidence with positive thinking. Conclusion: To provide patients information that related to the disease, the breast reconstructive surgery and the home care issue professionally, so that the patient can get comprehensive care for psycho social spiritual and implement the patient-centered perioperative care.

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