照護一位肺動靜脈畸形術後併發急性腦中風患者之護理經驗

本文描述一位診斷為肺動靜脈畸形接受手術後又併發腦中風的年輕患者加護護理經驗，2012年11月21日至11月30日照護期間，透過觀察、實際照護、會談及查閱病歷，以Gordon十一項健康功能型態進行護理評估，確立個案有呼吸道清除功能失效、術後疼痛及焦慮之護理問題。筆者在術後透過主動關懷與個案及家屬建立良好治療性人際關係，藉由教導正確肺部復健運動促痰液排除使呼吸道維持通暢；長吐氣呼吸法及止痛藥物使用使術後疼痛降低；因腦中風導致之肢體乏力問題，提供肢體復健運動；鼓勵表達焦慮不安的感受並提供足夠疾病相關訊息及衛教措施以減輕其焦慮情形，個案終能順利出院及勇敢面對後續復健之路。期望此護理經驗對日後照護此類病患能提供完整的照護參考。

關鍵字

肺動靜脈畸；肺葉切除；腦中風；疼痛；焦慮

並列摘要

This article describes a nursing care experience of a patient who developed post-operative stroke after surgery to correct the primary diagnosis of pulmonary arteriovenous malformation. Nursing assessment used observations, clinical care, interviews, review of patient records and Gordon 11 item Healthy Assessment. Nursing problems included ineffective airway clearance, post-operative pain, and anxiety. Post-surgery nursing interventions included patient teaching on pulmonary rehabilitation to remove sputum from the respiratory tract, prolonged exhale breathing, and postoperative pain management. Limb rehabilitation exercise helped to strengthen weak limbs caused by the stroke. The patient was provided with needed information, education, and encouragement to express concerns to reduce level of anxiety. The patient demonstrated strength and ability to continue the rehabilitation after discharge from the hospital. The author felt that this was a unique care experience of dual diagnosis and worth sharing with nursing colleagues.