青少年初次罹患自發性氣胸接受胸腔鏡肺楔狀切除術之護理經驗

本篇個案報告是筆者護理一位青少年初次罹患自發性氣胸且第一次接受胸腔鏡肺楔葉切除手術個案的經驗，護理期間為2010年1月2日至1月8日，以Gorden十一項健康評估，觀察及會談等方式，收集個案資料，並將資料加以歸納分析，確認個案有低效性呼吸型態、疼痛及焦慮之健康問題。筆者提供個案胸管照護注意事項、教導Triflow訓練、監測其生命徵象、提供傷口癒合資訊、給予止痛藥物及轉移注意力等措施。此外，個案正處於青少年階段，因治療過程而導致求學中斷，造成課業上的壓力，再在加上手術後插胸管留下的疤痕，導致其外觀的改變，使其身體心像受損。筆者提供青少年氣胸照護相關支持的網站，藉由同儕的力量來支持及克服疾病所帶來的衝擊和焦慮，最後，藉由醫療團隊之衛教來改善個案的呼吸型態和疼痛、焦慮等問題。期許此篇報告能提供外科護理人員於照護青少年自發性氣胸個案身心護理之參考。

關鍵字

自發性氣胸；胸腔鏡肺楔葉切除手術；護理經驗

並列摘要

This case report describes the experience of nursing a first spontaneous pneumothorax adolescent with thoracoscopic wedge resection. The duration of nursing care was between January 2nd and January 8th, 2010. The nursing process was evaluated with Gordon's 11 functional patterns. Related data were collected by evaluation, observation, and interview with the patient. Our case revealed three problems: anxiety, ineffective breathing pattern, and pain. The author provided the case the notes chest tube care, taught Triflow training, monitored vital signs, provided wound healing information, gave analgesic drugs and diverted attention. Additionally, during the adolescent period, the case school learning was interrupted due to the treatment that has caused his stress on schoolwork, and his body image also was disturbed because of the changing appearances due to the scans after inserting chest tube. The author has provided related internets about pneumothorax adolescent to support the case by peer power to overcome the impact and anxiety from the illness. Finally, the case's anxiety level was improved through the medical team education and also his pain and breathing pattern were altered. This case report is expected to provide the references on the physical and psychological nursing care of the spontaneous pneumothorax adolescent for the surgery nurses.

並列關鍵字

spontaneous pneumothorax ； thoracoscopic wedge resection ； nursing experience

被引用紀錄

戴淑芬、林心怡（2018）。照護一位罹患馬蹄腎青少女接受全腎切除手術之護理經驗。彰化護理，25(4)，84-97。https://doi.org/10.6647/CN.201812_25(4).0011

張簡凌薇、陳春香、湯婉孏（2021）。一位罹患月經性氣胸病人接受胸腔鏡切除術之護理經驗。長庚護理，32(2)，102-111。https://doi.org/10.6386/CGN.202106_32(2).0009

蔡夙珊、黃珮玲、許汶鈺、陳怡蓉、陳宜芳、陳怡靜、陳盈潓（2022）。提升護理人員對胸管存留護理指導之成效。嘉基護理，22(2)，1-14。https://www.airitilibrary.com/Article/Detail?DocID=1816661x-202212-202212260013-202212260013-1-14

延伸閱讀

Tung, Y. W., Hsu, C. P., Chuang, C. Y., Shai, S. E., Hsia, J. Y., Yang, S. S., & Chen, C. Y. (2002). 自發性氣胸在胸腔鏡輔助手術術後復發的手術處理經驗. 胸腔醫學, 17(3), 226-231. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200209-17-3-226-231-a
林嘉慧、蘇淑芳、蘇梅鳳、游淑英（2010）。一位肺炎合併肺膿瘍接受手術之學齡前兒童的照護經驗。弘光學報，(59)，1-12。https://doi.org/10.6615/HAR.201006.59.01
柯淑芬、穆淑珍、陳奕辰（2019）。一位青少年初次罹患原發型自發性氣胸之急診照護經驗。高雄護理雜誌，36(3)，144-155。https://doi.org/10.6692/KJN.201912_36(3).0013
張維倫、曾妮、黃明華（2017）。雙腔氣管內管合併獨立肺通氣應用於胸腔外傷個案之呼吸照護經驗。呼吸治療，16(1)，23-35。https://doi.org/10.6269/JRT.2017.16.1.03
SUGAMURA, Y., JIBIKI, M., IKARI, H., NAKAMURA, T., KAWABE, H., ISHIBASHI, T., & KUNIZAKI, T. (1995). Thoracoscopic Surgical Treatment of Spontaneous Pneumothorax: Selection of Surgical Therapy According to Thoracoscopic Findings. Diagnostic and Therapeutic Endoscopy, 1995(), 165-168. https://doi.org/10.1155/DTE.1.165

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青少年初次罹患自發性氣胸接受胸腔鏡肺楔狀切除術之護理經驗

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