照顧一位鼻竇炎病患行導航下鼻內視鏡切除術之手術全期護理經驗

本文為探討照護一位慢性鼻竇炎患者，行導航下鼻內視鏡切除術之手術全期護理經驗。筆者於2022年1月25日至2022年1月27日照護期間，運用Gorden十一項功能性健康型態評估工具，以觀察、會談、實際照顧等方式收集相關資料，確認個案護理問題有：一、焦慮／與重聽影響情緒及溝通及手術過程、手術室的陌生環境有關；二、潛在危險性手術情境傷害／與手術擺位不動及暴露在手術室低溫環境與器械儀器有關；三、疼痛／與術後傷口導致有關。針對上述健康問題，筆者於手術前訪視期間，利用多媒體衛教工具以及圖片介紹說明，並輔以能安撫其情緒的音樂、介入認知行為治療等措施，協助個案情緒得到放鬆，進而減輕手術前的焦慮程度；於手術中，提供正確擺位及適當防護措施，成功的避免個案於手術過程中產生皮膚損傷之情形，同時，全程以無菌技術操作，並確認手術器械及儀器之完整性，以確保個案於手術中之安全，預防手術情境的傷害；手術後，藉由提供個案降低術後疼痛相關衛教，以及利用觀看能緩解其情緒的巧虎卡通影集、聆聽周杰倫的歌曲等轉移注意力，以減緩疼痛問題。有感於手術室護理師與病人接觸時間短暫，無法對個案全盤瞭解，若能於手術全期各階段提供適宜的照護措施，將能有效提升照護品質，以此個案之照護經驗分享，提供臨床護理師之參考。

關鍵字

3D導航鼻內視鏡手術；焦慮；疼痛；手術全期護理

並列摘要

This article discusses the Preoperative nursing experience in caring for a chronic sinusitis patient with sinusitis undergoing navigation-assisted endoscopic sinus surgery. During the care period from January 25, 2022 to January 27, 2022, the author used Gorden's 11-item functional health assessment tool to collect relevant data through observation, interviews and actual care, and confirmed that the nursing diagnosis include (1) anxiety/related to the impact of hearing loss on mood and communication, surgical procedures, and the unfamiliar environment in the operating room; (2) potentially dangerous surgical situational injuries/related to immobility during surgery and exposure to the low-temperature environment and equipment in the operating room; (3) pain/related to postoperative wounds. In response to the above health problems, during the pre-surgery visit, the author used multimedia health education tools and picture introductions, supplemented by measures such as music that can soothe emotions and interventional cognitive behavioral therapy to help the patient relax emotionally and thereby reduce the risk of surgery. Correct positioning and appropriate protective measures are provided to successfully avoid skin damage during the operation. At the same time, the entire process is operated with sterile techniques and the integrity of the surgical instruments and instruments is confirmed to ensure the safety of the patient during the operation and to prevent injuries in the surgical situation. After the operation, the patient is provided with relevant health education to reduce postoperative pain, as well as through watching Qiaohu cartoon to relieve emotions and listening to Jay Chou's songs in order to divert attention to reduce pain level. In light of the fact that the operating room nurses have a short contact time with the patient and cannot fully understand the case, if appropriate care measures can be provided at all stages of the operation, the quality of care will be effectively improved. The care experience of this case will be shared to provide clinical reference for nurse practitioners.