照護年輕女性行斜視矯正手術之護理經驗

本文描述一位28歲年輕女性因右眼外斜視行斜視矯正手術後在恢復室之照護經驗，護理期間自2015年05月05日10:35至17:35共7個小時。筆者藉由直接照護、觀察、會談、身體評估等方式收集資料，進而確立個案有急性疼痛、舒適型態改變：噁心嘔吐及與焦慮等三項讓理問題。護理期間筆者以增加探視個案頻率與個案建立良好的護病關係，瞭解個案傷口疼痛情形適時給予冰敷、運用深呼吸放鬆技巧以減緩疼痛，並發揮護理獨特的功能性，協助個案半坐臥及口腔清潔護理，使噁心嘔吐感得以改善，鼓勵個案表達內心感受，確定焦慮事項，提供正確訊息，經由主治醫師直接解釋病況，以降低個案的焦慮。此次照護經驗中，深刻體會到護理人員若能多用心感受個案需求，給予適當的傾聽、陪伴及運用深呼吸放鬆等轉移注意力技巧可以減少個案不適感，並從個案手術清醒後焦慮情緒反應得知個案對疾病認知不足，因此建議應加強手術前的相關衛教、提供衛教指導單張，更可在手術前讓病人與家屬於手術前先至恢復室認識環境，減少術後因陌生環境造成的焦慮。

關鍵字

斜視矯正手術；疼痛；嘔吐；焦慮

並列摘要

This article describes a nursing experience of caring for a 28-year-old female patient post-strabismus surgery secondary to exotropia of the right oblique muscle at a post-anesthesia care unit. The nursing care period was seven hours from 10:35 a.m. to 5:35 p.m. on May 5, 2015. The author collected the data through direct care, patient observation, patient interview, and physical examination. Three identified nursing problems included acute pain and an altered comfort pattern: nausea/vomiting and anxiety. The author increased the frequency of visiting the patient to establish a good nurse-patient relationship, assessed the patient's surgical incision pain with the appropriate application of an ice pack, and taught the patient about relaxation skills through deep breathing for pain relief. The author implemented other nursing functions, such as assisting the patient when sitting in a semi-Fowler's position and cleaning the patient's mouth to improve nausea and vomiting. The patient was encouraged to express her internal feelings and anxiety. The primary physician directly explained the disease to the patient to relieve her anxiety. From this care experience, the author learned about empathizing the patient's care needs, lessening her discomfort through authentic listening, companionship, deep breathing relaxation, and distraction from pain. The author also recognized that the patient's anxious reaction was secondary to a knowledge deficit about her disease. Additionally, the author reinforced pre-operative relevant patient education and offered patient educational sheets. Arranging the patient and family to visit the post-operative recovery room may help decrease their anxiety due to the strange surroundings in the post- anesthesia care unit.