照顧一位機器手臂輔助再次瓣膜置換個案之手術全期護理經驗

本文描述照顧一位因風濕性心臟病導致瓣膜病變，入院行機器手臂執行二尖瓣瓣膜再次置換個案之手術全期護理經驗。因個案為醫護人員，深知再次手術易出血而煩惱，醫師建議使用機器手臂微創手術以降低出血風險，但是個案卻因使用新興醫療器械感到焦慮，故引發探討之動機。筆者於2016年6月22日至6月25日照護期間，運用訪談、傾聽、觀察、身體評估、直接照護及查閱病歷等方式收集資料，依手術全期護理架構執行整體性評估，歸納出個案有焦慮、高危險性皮膚完整性受損、潛在危險性感染及體溫過低等健康問題。術前藉由訪談、傾聽、提供心理支持及利用多媒體教學詳細說明機器手臂微創手術相關知識，減輕個案焦慮；術中提供安全的手術環境、正確姿位擺放及確實執行手術無菌技術，以預防高危險性皮膚完整性受損及潛在危險性感染；避免不必要的暴露並適時給予保暖，預防術後體溫過低，並持續追蹤管路、傷口有無感染情況及皮膚完整性。藉此照護經驗分享，期望對日後機器手臂輔助執行再次心臟瓣膜置換個案之手術全期照護有所助益，同時建議日後能制訂一份「機器手臂輔助二尖瓣瓣膜修補／置換手術臨床路徑」，使個案的手術照護品質更為連續及完整。

關鍵字

機器手臂輔助；再次二尖瓣瓣膜置換；手術全期護理

並列摘要

This article describes a perioperative nursing experience of caring for a patient with valvular heart disease caused by rheumatic heart disease receiving robotic-assisted redo-mitral valve replacement. The patient was a medical staff who was aware of and worried about the risk of bleeding tendency during reoperation, thus accepting the robotic-assisted minimally invasive surgery; yet he still felt uneasy of using this new technique, which was the motivation of the author. During the nursing period from June 22 to June 25, 2016, the author used interviews, listening, observation, physical assessment, direct care and medical records to collect data, and conducted a holistic assessment based on the perioperative nursing skill. It concludes the patient has anxiety, high risk of impaired skin integrity, potentially dangerous infections, and hypothermia. Before surgery, it was through interviews, listening, psychological support, and using multimedia to explain robotic-assisted minimally invasive operation to reduce the anxiety. During surgery, a safe operating environment was provided. The physiological needs were maintained. Proper surgical sterilization and patient positioning to prevent high-risk of impaired skin integrity and potentially dangerous infections were provided. After surgery, unnecessary exposure was avoided and timely warmth was given in order to prevent hypothermia. A follow-up skin integrity was continued and infection of drainage was prevented. By sharing this nursing experience, it is hoped it can benefit more patients who are receiving robotic-assisted re-operation on heart valve replacement. It is suggested that a ＂robotic-assisted mitral valve repair/replacement surgery clinical pathway＂ can be developed in the future to ensure the quality of nursing care through a more continuous and complete process.

並列關鍵字

robotic surgery ； redo mitral valve replacement ； perioperative nursing

參考文獻

Bashaw, M. A. (2016). Guideline Implementation: Preventing Hypothermia. Association of Operating Room Nurses Journal, 103(3), 304-313. doi:10.1016/j.aorn.2016.01.009

Chai-Adisaksopha, C., Hillis, C., Siegal, D. M., Movilla, R., Heddle, N., Iorio, A., & Crowther, M., (2016). Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thrombosis and Haemostasis, 116(5), 879-890. doi:10.1160/TH16-04-0266

Chi, N. H., Huang, C. H., Huang, S. C., Yu, H. Y., Chen, Y. S., Wang, S. S., & Wu, I. H. (2014). Robotic mitral valve repair in infective endocarditis. Journal of Thoracic Disease, 6(1), 56-60. doi:10.3978/j.issn.2072-1439.2014.01.05

Chikwe, J., Filsoufi, F., & Carpentier, A. (2014). Principles of Carpentier’s Reconstructive Mitral Valve Surgery. In W. R. Chitwood Jr (Eds.), Atlas of Robotic Cardiac Surgery (pp. 131-143). London : Springer. doi:10.1007/978-1-4471-6332-9

Demircelik, M. B., Cakmak, M., Nazli, Y., Şentepe, E., Yigit, D., Keklik, M., . . . Eryonucu, B. (2016). Effects of multimedia nursing education on disease-related depression and anxiety in patients staying in a coronary intensive care unit. Applied Nursing Research, 29, 5-8. doi:10.1016/j.apnr.2015.03.014

國際替代計量

照顧一位機器手臂輔助再次瓣膜置換個案之手術全期護理經驗

全文下載

主題瀏覽