- 期刊
一位結核性心包膜炎患者行心包膜切除術後之加護經驗
Post-operative nursing experience of a tuberculous pericarditis patient undergoing pericardiectomy surgery in an intensive care unit
摘要
本文敘述一位結核性心包膜炎個案引發心臟填塞行心包膜切除之術後加護經驗。針對生理、心理、靈性及社會發展等方面進行觀察與評估，確立主要護理問題為心輸出量減少、氣體交換障礙、急性疼痛及焦慮。筆者除了持續監測術後病人於強心劑和利尿劑使用下的血液動力數值，以達良好的組織灌流與體液之衡定，亦須注意心包膜與肋膜引流管的照護，以維持心臟的收縮功能，並且提供氧氣、執行胸腔物理治療及教導有效咳嗽方式，以維持正常的呼吸型態，確保肺部的通氣功能，同時指導疼痛控制技巧，傾聽、同理並舒緩個案焦慮和不安的感受。對於後續長期服用抗結核藥物之遵從性更應加強衛教，以有效控制疾病與感染復發的可能性，協助個案正向面對定期的追蹤治療與強化心肺耐力的復健運動，陪伴個案儘早接軌常規的生活。
並列摘要
This article describes the nursing experience of a tuberculous pericarditis patient who underwent pericardiectomy surgery due to cardiac tamponade. The physical, emotional, spiritual, and socio-developmental aspects of comprehensive assessment were applied to evaluate the patient's health status. Four main nursing problems were identified: decreased cardiac output, defect in oxygen exchange, acute pain and anxiety. In order to maintain heart function of the patient, diuretics and cardiotonic drugs were given according to the doctor's orders. In addition, the care of pericardial and retrosternal drainage tubes needed to be considered. Through oxygen therapy and chest physiotherapy, the patient's respiratory pattern was stabilized and his gaseous exchange function improved. Nursing education was offered to the patient in order to reduce his anxiety level, such as pain-relieving strategies and relaxation skills. Lastly, to help the patient return to a normal daily life, promote the adherence to anti-tuberculosis regimen for the prevention of the recurrence of infection was as important as motivating the patient to maintain regular follow-up treatment and post-operation cardiopulmonary rehabilitation exercise.
參考文獻
延伸閱讀
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