- 期刊
一位冠狀動脈繞道手術合併肺水腫之護理經驗
Nursing Experience of a Patient with Pulmonary Edema after Coronary Artery Bypass Graft Surgery: A Case Report
摘要
本文在探討一位因冠狀動脈疾病接受冠狀動脈繞道手術術後產生肺水腫病患之護理經驗。照護期間為2010年4月12日至4月26日，運用Gordon十一項功能性健康型態評估作為指引，經由身體評估、觀察、筆談、傾聽、追蹤訪談等方式收集個案主客觀資料，確立個案有「氣體交換功能障礙」、「急性疼痛」、「焦慮」三項護理問題。護理過程中，密切監測生命徵象、氧合狀態，有計畫的教導深呼吸運動、有效咳嗽、呼吸訓練及四肢全關節運動等心肺復健，改善氣體交換障礙問題，增進心肺功能而成功脫離呼吸器；在疼痛及焦慮方面，採集中護理、運用轉移注意力技巧及提供術後相關照護資訊，教導個案活動時避免牽扯傷口的方法，並利用主動關懷及傾聽，協助抒發不安情緒，能正向調適疾病並克服手術所帶來之衝擊，使個案恢復身體活動功能，為返家自我照護做好準備。
並列摘要
This report describes nursing experience when caring for a patient who had undergone coronary artery bypass graft surgery (CABG) with postoperative pulmonary edema. During the nursing period, which lasted from the 12th April to the 26th April, 2010, subjective and objective data were collected using Gordon's 11 Functional Health Patterns for use as an assessment tool. The approaches included physical assessment and observation as well as communication by writing, listening, and follow up interview. The identified nursing-related problems consisted of dysfunctional air exchange, acute pain and anxiety. Improved gas exchange, enhanced cardiopulmonary function and successful ventilator weaning were achieved by close monitoring of the patient's vital signs and oxygenation status together with the introduction of planned training in cardiopulmonary rehabilitation. The latter included practicing deep breathing, carrying out effective coughing and the use of respiratory training exercises. The patient was also trained in skills that helped to avoid wound tearing and in distraction techniques that were able to reduce pain. The patient's anxiety was eased by providing information on postoperative care and centralized nursing. These nursing initiatives encouraged the patient to speak out and express his thoughts. As a result, the patient successfully coped with the physical and mental impacts associated with his disease and surgery. His physical functioning was restored as a consequence of this facilitated postoperative rehabilitation.