一位主動脈瓣狹窄老年病患接受經導管主動脈瓣膜置換及永久性心臟節律器放置治療之護理經驗

Nursing Experience Related to Caring for an Elderly Aoritic Stenosis Patient with Transcatheter Aortic Valve and Permanent Pacemaker Implantations

徐靜儀(Ching-I Hsu) ； 鄭菁慧(Ching-Hui Cheng) ； 童恒新(Heng-Hsin Tung) ； 魏崢(Jena Wei) ； 陳慧玲(Hwei-Ling Chen) ； 李梅琛(Mei-Chen Lee)

《彰化護理》 24卷4期 (2017/12) Pp. 48-61

https://doi.org/10.6647/CN.201712_24(4).0006

摘要

本文描述一位主動脈瓣狹窄（aortic stenosis, AS）的老年病患接受經導管主動脈瓣膜置換（transcatheter aortic valve implantation, TAVI）及永久性心臟節律器放置治療的護理經驗，照護期間為2013年7月3日至2013年7月15日，筆者以Gordon十一項功能性健康型態收集資料及分析，發現個案因主動脈瓣狹窄以及TAVI術後合併心臟傳導阻滯，因此有心輸出量減少健康問題，需放置永久性心臟節律器（permanent pacemaker, PPM），術後則有無力感及知識缺失（主動脈瓣狹窄老年病患接受TAVI及PPM治療後之居家生活相關注意事項）之健康問題。針對心輸出量減少的問題，提供了增加輸出量護理措施，以減輕心臟工作負荷量，滿足身體所需之生命徵象；無力感問題方面，則藉由建立良好護病關係，引導表達内心感受並鼓勵參與照護活動，以增強個案對現況控制感；知識缺失（主動脈瓣狹窄老年病患接受TAVI及PPM治療後之居家生活相關注意事項）部分，予教導抗凝血藥物服用之飲食及居家生活注意事項，以及PPM放置後之傷口護理與返家後自我照護活動，以提升居家生活品質。期望此TAVI術後照護經驗，能提供給日後臨床護理人員照護類似個案的參考與分享。

關鍵字

主動脈狹窄 ； 老年人 ； 經導管主動脈瓣膜置換 ； 永久性心臟節律器放置

並列摘要

This article describes the nursing experience of caring an elderly aortic stenosis (AS) patient who received a transcatheter aortic valve replacement implantation (TAVI) and permanent pacemaker (PPM) implantation. The period of nursing care was from July 3, 2015 to July 15, 2013. The authors collected and assessed the patient's health problems according to the Gordon 11 Functional Health Patterns Method and identified nursing problems such as low cardiac output (due to AS and post-TAVI conduction disorders), powerlessness, and lack of knowledge about taking anticoagulants, wound care, and self-care at home. To manage low cardiac output, nursing interventions were applied to increase the cardiac output, reduce heart workload, and stabilize the vital signs to supply enough blood to the entire body. To treat powerlessness, a nurse-patient relationship was established to encourage the patient to express concern and personal feelings to enhance the patient's own sense of control over her life plans and confidence in her ability to manage her condition. Additionally, the patient was informed about diet and contraindications to anticoagulants, PPM wound care, and other related health education to promote quality of life. Finally, the author hoped this nursing experience can be used as a reference by nursing staff caring similar client in the future.

並列關鍵字

aortic stenosis ； elderly patient ； transcatheter aortic valve implantation ； permanent pacemaker implantation

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