- 期刊
一位接受膽道閉鎖手術嬰兒之護理經驗
Post-operative Nursing Experience in Caring for a Neonate With Biliary Atresia
摘要
本文描述一位膽道閉鎖新生兒接受葛西式手術之照護經驗，照護期間為2016年8月1日至9月3日，筆者以觀察個案、與家屬透過會談、關懷及傾聽等方式收集資料，運用Gordon十一項健康功能評估，確立個案有現存性危險性感染、營養不均衡、急性疼痛及照顧者角色緊張的健康問題。在現存性危險性感染方面：安排洗手設備旁之床位、嚴守無菌及手部衛生，降低傷口及管路感染風險；在營養不均衡方面：跨團隊討論制定個案的營養計畫，配合個案進食情形，適時調整熱量及選用特殊配方奶，以提升病人所需之營養；在急性疼痛方面：採集中護理、藥物治療及寧握、袋鼠護理及非營養性吸吮，減少個案疼痛情形；在照顧者角色緊張方面：了解家屬需求，製作『分藥劑量配置表』，減少父母返家照顧的不安。建議可增設照顧重症兒童護理人員之心理輔導課程、適時舉行跨團隊照護討論會和建立新生兒疼痛照顧規範，藉此提升護理人員的溝通與照護能力，合乎「以家庭為中心」護理，期望藉此經驗分享，以提供日後護理人員照護之參考。
並列摘要
The article described the experience of post-operative nursing in caring for a newborn who had the surgery as the result of biliary atresia, namely the Kasai procedure. The period of the nursing care provision was from August 1 to September 3, 2016. By using the assessment tool of Gordon's Functional Health Patterns, through observation, interviews and listening to the parents, four significant caregiving issues were raised. First, to lower the infection risk, we had arranged accessible hand-washing equipment at every bedside, strictly followed the rules in keeping aseptic techniques and hand hygiene whenever executing the nursing procedures, and keeping the wound and invasive medical devices clean and sterile at all times. Second, to make improvement in the nutritional status, we had made the nutritional plan according to the patient's unique needs and adjusted the calories intake as necessary and therapeutic formula that depended on the patient's feeding condition, in addition of arranging regular case conference with multidisciplinary team members regarding the patients progress and needs. Third, as for the acute pain control, acute pain was relieved by clustering caregiving, kangaroo care, non-nutritive sucking and painrelieving medication. Fourth, regarding the caregiving stress of the caregivers, we had inititated several support strategies including understanding the needs of the family members by creating a table enlisting each drug dosage and route and assisting with the potential issues of home care for the caregivers. In order to improve the communication and the quality of care provided by nursing staff, ＂family-centered＂ nursing care was the foundation by which we recommended a course provided by psychology consultant for the nursing staff working in pediatric intensive care unit (PICU), having case conferences regularly with multidisciplinary team members, and revising the guidelines in managing acute pain control in newborn.