一位心室中膈缺損開心術後嬰兒之加護護理經驗

The Experience of Post-Operative Nursing Care for an Infant with Ventricular Septal Defect in a Pediatric Intensive Care Unit

謝佳妤(Chia-Yu Hsieh) ； 蔡美容(Mei-Rong Tsai) ； 楊佰能(Bai-Neng Yang)

《馬偕護理雜誌》 14卷1期 (2020/01) Pp. 25-36

https://doi.org/10.29415/JMKN.202001_14(1).0003

摘要

本文探討一位心室中膈缺損合併心衰竭症狀接受開心手術個案之加護照護經驗。照護期間自2017年2月10日起至2月28日，以觀察、訪談、評估、記錄等技巧，進行家庭、生理、心理、社會及靈性等層面收集資料，確認健康問題包括：低效性呼吸型態、高危險性感染、急性疼痛及主要照顧者角色緊張。筆者提供主動關懷照護，評估個案需要，監測血液動力學變化，維持穩定生命徵象，給予噴霧治療、姿位引流協助排除痰液改善呼吸型態；透過監測感染指數、觀察傷口以及導管周圍皮膚情形、依醫囑使用抗生素，密切監測有無感染徵象；給予患者採舒適臥位，集中式護理，降低患者疼痛情形，進而減少因疼痛躁動造成心臟之負荷，透過主動關懷，協助案父母了解個案照護計劃及學會術後照顧之注意事項，減緩主要照顧者緊張情緒，提升其親子依附關係，進而提高其返家後照護個案之自信。期望藉此經驗分享給護理人員參考。

關鍵字

先天性心臟病 ； 心室中膈缺損 ； 嬰兒 ； 加護護理 ； 開心手術

並列摘要

This case study was to explore the nursing care of an infant with ventricular septal defect combined with cardiac failure symptoms underwent open-heart surgery in an pediatric intensive care unit. The duration of nursing care was from 10th of February to 28th of April in 2017. Methods of observation, interviews, assesment and recording were used to collect the data about family history, physiological parameters, emotional aspects, socio-economic status and spirituality issues. The author concluded that the nursing problems were as below: an ineffective respiratory pattern, high risk for infection, acute pain and role strain in the primary caregiver. Therefore, the author had provided proactive care to assess the needs of the infant and her caregiver, monitored the changes in hemodynamics, stabilized her vital signs, observed the wounds and skin around the catheter, and monitored the data in relation to infection signs to confirm if an infection had occurred. Other interventions such as assisting comfortable position, intensive nursing care and pain control for relieving pain and sustained heart load were made in addition to help parents understand the care plan and learn about the postoperative care skills in order to alleviate the caregiver's role strain and improve the relationship between the parents and the infant. The author wish to use this report to share the experience with other nurses.

並列關鍵字

congenital heart disease ； ventricular septal defect ； infant ； intensive nursing ； heart surgery