無體外循環冠狀動脈繞道手術病人之手術全期護理經驗

Perioperative Nursing Experience in a Patient Accepting Off-Pump Coronary Artery Bypass Surgery

劉淑娟(Shu-Chuan Liu) ； 張德馨(Te-Hsin Chang)

《馬偕護理雜誌》 2卷2期 (2008/07) Pp. 59-70

https://doi.org/10.29415/JMKN.200807_2(2).0006

摘要

本報告是探討一位中度肥胖之七十五歲男性，因冠狀動脈阻塞接受無體外循環冠狀動脈繞道手術之手術全期護理。護理期間為2006年8月18至8月28日止。筆者於術前訪視時運用傾聽、關懷技巧，讓病人願意表達其感受，對手術的期望等，澄清一些不正確的觀念，給予有關手術的適當護理指導，與個案建立良好的護病關係，使個案能以正向態度面對因開心手術造成身體和心靈各方面的壓力，進而能使病人能如期出院且返家後復原情形良好。在術前訪視過程中筆者運用Gordon十一項功能性健康型態評估指引，及應用身體評估的技巧，發現個案有：焦慮、手術期間之潛在危險性皮膚及神經傷害、潛在危險性體溫改變、潛在危險性感染等護理問題。本文的主要護理措施為：安排手術前訪視讓病人將焦慮減到最低程度，在長時間之手術期間，運用手術擺位及保護性約束，減少對皮膚及神經的傷害，密切監控體溫及給予保暖措施，降低手術失溫導致之後續傷害，遵守及執行無菌原則以預防術後感染情形發生。

關鍵字

手術全期護理 ； 無體外循環冠狀動脈繞道手術 ； 護理經驗

並列摘要

The article described the nursing experience for a 75-year -old obese man accepting off-pump coronary artery bypass (OPCAB) surgery. The nursing period was from 18 to 28 Aug., 2006. The author let the patient express the feelings and expectations for the surgery and clarify his incorrect concepts based on listening and concern skills. The patient could face physiological and psychological stress with positive attitude by the aid of good interactions with medical staff after health education. As assessed by Gordon's 11 functional patterns and skills in body evaluations it was noted that the patient having anxieties for the risks of surgical position, body temperature change, and infection. Nursing procedures in the article included to lower the patient's anxiety as low as possible, to avoid the cutaneous and nervous injuries during surgical positioning, and to lower the possibilities of post-operative injuries and infections. The patient could then gain the good recovery in physiological and psychological status by proper nursing care.

並列關鍵字

perioperative nursing ； off-Pump coronary artery bypass surgery ； nursing experience