照顧一位漏斗胸病人行納氏矯正手術之護理經驗

The Nursing Experience of Caring a Patient with Pectus Excavatum Post NUSS Procedure

王瓊瑛(Chiung-Ying Wang) ； 吳雪紅(Hsueh-Hung Wu)

《源遠護理》 11卷1期 (2017/03) Pp. 60-67

https://doi.org/10.6530/YYN/2017.4.2

摘要

本文探討一位36歲女性，因漏斗胸喘、疲倦及呼吸道感染反覆就醫，影響生活品質，入院接受納氏手術之護理經驗，護理期間自2014年3月13日至3月23日，筆者藉由觀察、會談、身體評估及Gordon十一項功能性健康型態評估工具收集主客觀資料並分析，確認個案有：焦慮、疼痛、身體活動功能障礙等問題。藉由圖片解釋手術過程及成功個案經驗分享並以疼痛評估量表評估後與醫師討論用藥、給予護理指導以轉移疼痛注意力及教導漸進性活動提供患者照護。筆者依所呈現之問題提供措施後，個案能主訴焦慮減輕、疼痛分數由10分降至3分，出院時能執行正確的活動型態。此為近年新興之手術與照護，建議將護理指導及復健活動拍成影片，藉由媒體讓病人有更具體及完整之參考依據，進而提升護理照護的品質。

關鍵字

漏斗胸 ； 納氏手術 ； 護理經驗

並列摘要

This article discusses a 36-year-old female undergoing NUSS surgical procedure. She experienced repetitive respiratory tract infection and shortness of breath due to her pectus excavatum condition. Data were collected through observation, interview and physical assessment. According to Gordon's 11-item functional health assessment, the patient's problems included anxiety, pain and mobility disability. Patient teaching used graphic illustration of the surgical process and sharing the successful experience to relive patient's anxiety. Pain management included the use of pain scale, pain medications and non-pharmaceutical measures. Patient teaching also included steps on progressive rehabilitation to improve her daily activities. The patient reported pain reduced from 10 to 3 on the scale of 1-10. The author recommends developing a teaching video on nursing instruction and rehabilitation activities for this newly-developed operation and nursing care. It will provide patients a substantial and integrated comprehension about the procedure and also fortify the quality of nursing care.

並列關鍵字

pectus excavatum ； NUSS procedure ； care experience

參考文獻

黃馨、楊美琪、李亭亭（2007）．納式手術—微創漏斗胸矯正術之護理．護理雜誌，54（6），73-76。doi:10.6224/IN.54.6.73。

Bogert, J. N., Potter, D. D., Moir, C. R., Haile, D., & Wilder, R. T., (2013). Patient-controlled analgesia-based pain control strategy for minimally invasive pectus excavatum repair. Surgical Practice, 17(3), 101-104. doi:10.1111/1744-1633.12017.

Hanna, W. C., Ko, M. A., Blitz, M., Shargall, Y., & Compeau, C. G., (2013). Thoracoscopic Nuss procedure for young adults with pectus excavatum: Excellent midterm results and patient satisfaction. The Annals of Thoracic Surgery, 96(3), 1033-1038. doi:10.1016/j.athor.acsur.2013.04.093

Purser, L., Warfield, K., & Richardson, C. (2014). Making pain visible: An adult and review of documentation to improve the use of pain assessment by implementing pain as the fifth vital sign. Pain Management Nursing, 15(1), 137-142.doi:10.1016/j.pmn. 2012.07

肖仁梅、冉秦、越紅英（2011）．康復訓練健康教育路徑在漏斗胸患兒圍術期中的應用效果．解放軍護理雜誌，3，14-20。