一位行冠狀動脈繞道手術個案術後合併心肺衰竭之護理經驗

An Experience of Nursing a Patient Who Underwent a Coronary Artery Bypass Graft Procedure and Cardiopulmonary Failure

李姿月(Tzu-Yueh Lee) ； 胡倩青(Chien-Ching Hu)

《安泰醫護雜誌》 23卷2期 (2017/12) Pp. 31-44

摘要

本文探討一位30歲女性，行冠狀動脈繞道手術合併心肺衰竭，成功脫離呼吸器之護理經驗。護理期間自2015年11月16日至12月7日，運用歐倫自我照顧理論指引經由身體評估、筆談、觀察、傾聽及查閱病歷等技巧收集病史，確立個案有氣體交換障礙、睡眠型態紊亂、焦慮之健康問題。照護期間每班聽診呼吸音、監測動脈氧氣濃度，教導有效的深呼吸及咳嗽技巧；夜間睡眠調整室內燈光；維持個案和重要親友的正向關係，讓個案及家屬主動參與計畫；透過成功患者的激勵，建立個案脫離呼吸機的希望，進而成功脫離呼吸機，希望此報告作為臨床脫離呼吸器個案之照護參考。

關鍵字

冠狀動脈繞道手術 ； 心肺衰竭 ； 肺部復健運動

並列摘要

This article describes a nursing experience of caring for a 30-year-old patient who experienced heart failure and underwent coronary artery bypass grafting due to experiencing an acute coronary syndrome. Nursing care was provided from the 16th of November 2015 to the 17th of December 2015. During this period of time, the medical practitioner collected and analyzed this client's data while providing direct care, using consulting skills, listening, and observing the client. The whole process of nursing assessment was based on Orem's self-care theory assessment; and from this assessment. The medical practitioner identified three major health problems which were dysfunctional gas exchange, sleep pattern disruption, and anxiety. Through providing appropriate nursing assessment such as auscultation of breathing sounds and monitoring arterial oxygen levels in each shift, appropriate interventions were provided such as coaching the patient to have effective deep breathing and coughing skills, and adjusting lighting to decrease stimulation during the night. The medical practitioner also provided several psychologically oriented interventions such as helping the client to maintain a positive relationship with close family members, and encouraging the patient to set up care plans and achievable goals with the help of her family members. Furthermore, experiences were shared about how patients have successfully weaned themselves off from mechanical ventilation, and this helped to increase the client's confidence about ventilator weaning. It is hoped this case report will be useful to assist other health providers to provide care in similar cases.

並列關鍵字

Coronary artery bypass graft ； cardiopulmonary failure ； pulmonary rehabilitative exercise