照顧一位心臟術後併發低效性呼吸型態病人之護理經驗

Nursing Care for a Patient with Ineffective Breathing Patterns after Cardiac Surgery

盧盈方(Ying-Fang Lu) ； 林心怡(Hsin-Yi Lin)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 23-35

https://doi.org/10.6740/NTUHJN.201907_15(2).0004

摘要

本文為一位冠狀動脈繞道及瓣膜置換與修補術後病人，因活動喘及傳統觀念影響，使其無法順利配合執行心肺復健，遂引發照護動機。於2016年4月15日至4月28日藉由直接照護、訪談、觀察及查閱病歷方式評估及收集資料，運用Gordon 11項功能性健康型態模式，確立個案主要健康問題為低效性呼吸型態、知識缺失及焦慮等。照護過程中鼓勵及早下床，教導使用誘發性肺功能器（triflow）、腹式呼吸及深呼吸咳嗽技巧等措施改善肺部合併症，採主動關懷及傾聽陪伴方式建立護病關係，提供術後照護正確資訊，導正傳統術後需多休息的觀念以利術後心肺復健進行，並引導正向思考及教導轉移注意力技巧減緩焦慮，藉此多重措施改善個案陷入術後需多休息、心臟復健遲滯與復原不如預期而焦慮的惡性循環中。建議照護心臟外科術後病人時，能多主動關懷、傾聽陪伴、同理病人感受，建立良好的護病關係，確實了解病人無法配合執行心肺復健原因為何，針對其不適及擔憂給予適當的護理措施及衛教指導，以達更完善之護理品質。

關鍵字

低效性呼吸型態 ； 心臟手術

並列摘要

The post-operative care of patients undergoing coronary artery bypass graft, valve repair, and valve replacement is challenging. We described a patient who could not perform rehabilitation activities because of shortness of breath and false beliefs. We collected information on her care from April 15 to 28, 2016 through interviews, observation, and chart review. Gordon’s 11 Functional Health Patterns were used by nurses to assess this patient’s ineffective breathing patterns, knowledge deficits, and anxiety. To reduce pulmonary complications, the patient was taught tri-flow using early ambulation, abdominal breathing, deep breathing, and coughing. We listened to the patient and accompanied her throughout the process. To help her with cardiopulmonary rehabilitation, we educated her about correct concepts, thinking positively, and distraction skills to reduce anxiety. We were able to interrupt the unproductive cycle of too much rest causing anxiety and delayed recovery. We suggest that principles of caring, listening, and accompanying should be used to build a good relationships with patients. To offer appropriate interventions and improve nursing quality, we must understand why patients are unable to perform rehabilitation activities.

並列關鍵字

ineffective breathing pattern ； cardiac surgery