照護一位心臟手術後合併胸骨感染患者之經驗

本文描述一位心臟手術後併胸骨傷口感染患者的住院護理經驗。於2014 年7 月2 日至7 月20 日護理期間，運用Gordon 十一項健康功能型態表作為評估工具，確立個案有現存性感染、急性疼痛及焦慮等健康問題。筆者藉實際操作與回覆示教闡明洗手的重要性、協助選用促進傷口癒合食物、依傷口特性採用生理食鹽水濕敷換藥方式並增加換藥次數，依據菌種使用合宜的抗生素等，有效改善傷口感染問題；教導非藥物性疼痛緩解技巧、澄清對止痛劑的疑慮，換藥中執行疼痛評估、將黏附於傷口之紗布潤濕後再取下的技巧等，使個案因換藥導致的疼痛感得以緩解；透過參與換藥過程、提供及說明感染相關檢驗值變化等方式建立正向態度，緩解因傷口感染導致的不安感受。透過此次照護發現，臨床上護理人員的疼痛衛教指導多在疼痛發生時才開始進行，病患使用過止痛藥物後，往往會認為緩解疼痛要靠打針吃藥才能有效，非藥物性緩解疼痛的輔助措施則難以再被接受，故建議將非藥物性止痛處置編入「手術前指導事項」單張、懸掛「緩解疼痛的技巧」海報於病房走廊等明顯處，改變疼痛衛教的時機點，期望能使病患有更完整的疼痛控制觀念。

關鍵字

胸骨傷口感染；急性疼痛；焦慮

並列摘要

Nursing experience in caring a patient with sternal wound infection following cardiac surgery was demonstrated in the article. Using Gordon's 11 Functional Health Patterns Assessment, active infection, acute pain, and anxiety were defined as the major health problems of the patient during July 2nd to July 20th, 2014. To reduce the bacterial burden of the sternal wound, the author used strategies including hand-washing frequently, using sterile wet-to-dry dressing, and increasing the frequency of dressing change if necessary. The patient was also taught to take the protein-rich and vitamins-rich foods to facilitate the process of wound healing. To alleviate acute pain, the author used both analgesics and non-analgesic methods. Dampening the packed gauze before its removal and making the patient take diaphragmatic breathing were two useful non-analgesic skills to meet the purpose. To reduce the patient's anxiety about wound infection, the author actively informed the patient about the progression of wound healing. After doctors' explanations, the author also provided emotional supports or colloquial explanations of some medical problems such as drugs' side effects or updated laboratory data to comfort the patient and her family. Based on this nursing experience, the author suggested to increase non-pharmaceutical strategies, such as patient education before surgery and offer more integrated pain management program for patients.