一位接受冠狀動脈繞道手術個案加護護理經驗

Nursing Experience of Caring a Patient Undergoing Coronary Artery Bypass Graft Surgery in the ICU

洪穀崑(Gu-Kun Hong) ； 陳碧君(Bi-Chun Chen)

《領導護理》 19卷3期 (2018/09) Pp. 66-79

https://doi.org/10.29494/LN.201809_19(3).0006

摘要

探討一位接受冠狀動脈繞道手術病人運用心肺復健成功脫離呼吸器之加護經驗。護理期間自2016年08月17日至09月5日，運用Gordon十一項型態評估，參與照護、身體評估及筆談等評估，確立護理問題為急性疼痛、氣體交換功能障礙、焦慮等護理問題。面臨傷口疼痛、疾病預後和陌生環境等引起焦慮，導致訓練呼吸過程屢次失敗，協助執行呼吸訓練、心肺訓練，讓病人參與呼吸訓練，衛教疾病認知、言語鼓勵和家人支持，鼓勵表達其感受以緩和焦慮情緒，促進病人順利拔除呼吸器轉出加護病房。因受限於病人為緊急狀況，無法術前衛教，故建議製作相關影片或多媒體作為術後病人的衛教，以增加其對手術後的認知和減低焦慮感。希冀藉由此次照護經驗提供日後相關疾病照護之參考。

關鍵字

冠狀動脈繞道手術 ； 疼痛 ； 焦慮 ； 呼吸器脫離訓練

並列摘要

This article aims to discuss the experience from a case of coronary artery bypass surgery. Nursing period started from August 17, 2005 to September 5, 2015, by applying Gordon 11 type of assessment, participation in care, physical assessment, writing and other assessment, the establishment of nursing problems for acute pain, blood gas exchange dysfunction, anxiety and other nursing problems. Facing wound pain, disease prognosis and unfamiliar environment caused by anxiety, resulting in repeated training and breathing failure, to assist in the implementation of breathing training, cardiopulmonary training, so that cases involved in breathing training, health education awareness, language encouragement and family support, to encourage the expression of their feelings. Relieve anxiety, to promote the smooth removal of the case of breathing apparatus out of the intensive care unit. It is recommended that the relevant film or multimedia to be produced for a postoperative patient's health education to increase the awareness of post-operative care and reduce anxiety. Hopefully by sharing this case study, it became a source of reference for future nursing care.

並列關鍵字

Coronary artery bypass surgery ； pain ； anxiety ； breathing training

參考文獻

林鎂喻、何美瑤、蔣秀容、黃鳳玉（2013）．冠狀動脈繞道術後病人生活品質之探討．榮總護理，30(1)，45-52。doi:10.6142/VGHN.30.1.45

施孟綾、廖玉美（2014）．照顧一位主動脈剝離手術後患者呼吸器脫離困難之護理經驗．新臺北護理期刊，16(1)，83-92。doi:10.6540/NTJN.2014.1.009

張佳雯、李姿月、李彩緣（2013）．一位冠狀動脈繞道手術合併肺水腫之護理經驗．北市醫事雜誌，10(1)，89-99。doi:10.6200/TCMJ.2013.10.1.12

郭思妤、陳秀玲（2014）．照護一位行冠狀動脈繞道手術後病人之護理經驗．高雄護理雜誌，31(1)，52-72。doi: 10.6692/KJN-2014-31-1-7

童惠芳、白玉珠、林柏瑤、陳美娟、蔡雅琪（2012）．分析手臂運動訓練對病人脫離呼吸器之成效．護理暨健康照護研究，8(2)，138-148。doi:10.6225/JNHR.08.2.138