照顧一位行次全甲狀腺切除手術患者之手術全期護理經驗

Perioperative Care of a Patient Undergoing Subtotal Thyroidectomy

余惠美(Hui-Mei Yu) ； 邱月芳(Yueh-Fang Chin) ； 王桂英(Kuei-Ying Wang)

《馬偕護理雜誌》 5卷1期 (2011/01) Pp. 52-60

https://doi.org/10.29415/JMKN.201101_5(1).0006

摘要

本報告是探討一位非毒性多發性結節甲狀腺腫瘤患者接受手術治療之護理經驗。護理期間自2009年4月5日至2009年4月11日。筆者以手術室護理人員的角色，在手術前、中、後期透過觀察、傾聽、會談、參閱病歷紀錄及運用身體、情緒、智能、社會、靈性五大層面等評估方式收集資料。在手術前期：焦慮／面對麻醉及手術過程認知缺乏；照顧者角色緊張／（家屬的焦慮）／缺乏手術中訊息；手術中期：潛在危險性皮膚完整性受損／因手術整個過程須維持平躺姿勢固定不動，與使用電燒器容易造成電燒傷問題；手術後期：急性疼痛／麻醉藥物的消退產生手術傷口疼痛。在護理過程中，筆者藉由術前訪視，與個案及家屬建立良好互動關係，並透過術前的訪視、術中的安全照護、術後的衛教及出院後電訪個案，給予個案完整的手術全期照護，有助於提升個案自我照顧能力，達到最佳健康狀況，並且能儘快恢復以往之生活。

關鍵字

次全甲狀腺切除 ； 手術全期護理 ； 焦慮

並列摘要

A 40-year-old man underwent subtotal thyroidectomy for non-toxic nodular goiter and thyroid cancer. I cared for the patient for 6 days as a member of the nursing staff in an operating room. I collected data through observation, listening, conversations, reading the medical record, and assessing the patient's physical, emotional, mental, social, spiritual dimensions. Prior to surgery, the patient was anxious and didn't understand much about the anesthesia and surgical procedure themselves. His family members had similar concerns. During the surgery, physical issues included impairment of skin integrity, the uncomfortable position the patient needed to maintain throughout the procedure, and the potential for burns from electrocautery. Postoperatively, there was pain as the anesthesia and analgesia wore off. The nursing process included preoperative visits to build good interactive relationships with the patient and his family. During surgery, attention was paid to maintaining safety. Postoperatively, I provided health education and followed up with post-discharge telephone interviews. This comprehensive perioperative nursing improved the patient's ability to care for himself and recover quickly to his former state of good health.

並列關鍵字

subtotal thyroidectomy ； perioperative nursing ； anxiety