照護一位幼兒行人工電子耳之手術全期護理

The Perioperative Nursing Experience of Caring A Child who Underwent Artificial Electronic Ear Surgery

吳珈樺(Jia-Hua Wu) ； 楊曜蓮(Yao-Lian Yang) ； 葉惠玲(Hui-Ling Yeh)

《長庚護理》 34卷1期 (2023/03) Pp. 102-111

https://doi.org/10.6386/CGN.202303_34(1).0009

摘要

本文是照護一位1歲7個月幼兒因雙耳感覺神經性聽力損失，行左耳人工電子耳手術之手術全期照護經驗。護理期間為2019年7月4日至7月8日，運用Gordon十一項健康功能評估工具，並藉由查閱病歷、病房訪視、身體評估、會談和觀察進行資料收集，確立個案健康問題有照顧者角色緊張、潛在危險性損傷、潛在危險性感染。在護理過程中進行術前訪視，發現主要者對人工電子耳的資訊缺乏造成緊張，利用圖片解答疑惑以增加人工電子耳相關資訊，降低緊張。手術採仰臥位，手臂至於身體兩側，保持掌面朝上，雙膝下及足跟處放置枕頭及棉被預防垂足，溫毯上需放置布單，避免與個案皮膚直接接觸。手術結束後無神經、皮膚損傷發生、手術後期左耳後有傷口存在，個案無自理能力，向主要照顧者教導傷口照護，以預防傷口感染。2019年12月20日電訪，主要照顧者曾祖母表示個案對於人工電子耳適應良好，並且已能發出媽、爸簡單的音。藉由此個案手術全期照護經驗提供日後護理人員照護之參考。

關鍵字

雙耳感覺神經性聽力損失 ； 人工電子耳 ； 手術全期護理

並列摘要

This case report addresses the perioperative nursing experience of a 1-year-old and 7-month-old child with binaural sensorineural hearing loss who has undergone the surgical operation of the left ear artificial electronic ear surgery. The nursing period was from July 4 to July 8, 2019, using Gordon's eleven health function assessment tools, and collecting data by consulting medical records, ward visits, physical assessments, interviews and observations to establish that the case has health problems. The patient major issues were identified: the caregiver's role strain, potentially dangerous injuries, and potentially dangerous infections. During a preoperative visit during the nursing process, it was found that the the caregiver's was nervous about the lack of information on the artificial electronic ear. The pictures were used to answer doubts to increase the artificial electronic ear related information and reduce the tension. Surgery position is the supine, arms are on both sides of the body, keep palms facing up, pillows and quilts are placed under the knees and heels to prevent sagging feet. A cloth sheet should be placed on the warm blanket to avoid direct contact with the patient's skin. After the operation, No nerve or skin damage occurred. There was a wound behind the left ear at the end of the operation, and the patient was unable to take care of himself. The main caregiver was taught wound care to prevent wound infection. In a telephone interview on December 20, 2019, the main caregiver's great-grandmother said that the case was well adapted to artificial electronic ears and was able to make simple sounds of mom and dad. The case report may serve as a reference for future nursing staffs when caring similar cases.

並列關鍵字

Acute pain ； artificial electronic ears ； perioperative nursing

參考文獻

丁冠中、蕭安穗 (2017)．人工電子耳在老年人的 應用．臨床 醫學 月刊，80(1)，379-381。[Ting, K. C., & Shiao. A. S. (2017). Application of cochlear implant in the elderly. Clinical Medicine, 80(1), 379-381.] https://doi.org/10.6666/ClinMed.2017.80.1.071。

吳哲民、鄒詠婷 (2015)．人工電子耳綜論．台灣 耳鼻 喉頭 頸外 科雜 誌，50(4)，197-210。[Wu, C. M., & Tsou, Y. T. (2015). Cochlear implantation. The Journal of Taiwan Otolaryngology-Head and Neck Surgery, 50(4), 197-210.] https://doi.org/10.6286/2015.50.4.197。

楊政晧、吳丁樹．(2017)．預防手術部位感染組合式照護．內科學誌，28(1)，7-11。[Yang. J. H. & Wu. T. S. (2017). Bundle care strategies in surgical site infection prevention. Journal of Internal Medicine of Taiwan. 28(1), 7-11.] https://doi.org/10.6314/JIMT.2017.28(1).02。

Lin, P. H., Hsu, C. J., Lin, Y. H., Lin, Y. H., Lee, H. Y., Wu, C. C., & Liu, T. C. (2017). Etiologic and audiologic characteristics of patients with pediatric-onset unilateral and asymmetric sensorineural hearing loss. JAMA Otolaryngology-- Head & Neck Surgery, 143(9), 912-919. https://doi.org/ 10.1001/jamaoto.2017.0945。

Wilson, B. S., Tucci, D. L., Merson, M. H., & O' Donoghue, G. M. (2017). Global hearing health care: new findings and perspectives. The Lancet, 390(10111), 2503-2515. https://doi.org/10.1016/S0140-6736(17)31073-5。