冠狀動脈繞道手術病人之手術全期護理照護

The Perioperative Nursing Care of a Coronary Artery Bypass Graft Patient

劉雪嬌(Hsueh -Chiao Liu) ； 吳孟凌(Meng-Ling Wu)

《北市醫學雜誌》 7卷3期 (2010/09) Pp. 304-312

https://doi.org/10.6200/TCMJ.2010.7.3.13

摘要

本篇旨在描述一位接受冠狀動脈繞道手術病人之手術全期護理經驗，護理期間為2008年4月13日至14日，運用生理、心理、社會、靈性、發展等五大層面為評估架構，經由直接照顧、身體評估、觀察、會談等方式收集資料，發現病人有：（一）焦慮／面對高危險性的手術與未知的結果及鄰居負向經驗有關；（二）高危險性手術情境的傷害／全身麻醉、手術擺位、體外循環機使用、手術時間冗長有關；（三）高危險性感染／手術過程、手術傷口、導尿管、呼吸器、CVP、動脈導管、胸管有關；（四）呼吸道清除功能失效／手術結束後GCS：E1VTM1、呼吸器使用有關等健康問題。經由術前訪視藉由傾聽、關懷病人並提供手術訊息、術中持續性監測生命徵象並維持血液動力學之穩定、提供生理上照護、維持手術無菌之狀況、維持手術姿勢正確擺位、術後立即給予個案身上鋪蓋回溫毯、抽痰、呼吸音聽診等護理措施介入後，結果個案能緩解面對手術焦慮，於手術後無肺部、手術傷口及管路之感染發生，並能於術後一週內康復出院。

關鍵字

冠狀動脈繞道手術 ； 手術全期護理

並列摘要

The objectives of this paper are to report the findings during the perioperative nursing care of a coronary artery bypass graft (CABG) patient who was assessed using five dimensions, namely physiology, psychology, society, spirituality and development from the 12th to the 13th of April 2008. The research data was collected via direct care, physical assessment, observation and interview. It is found that the patient was experiencing four conditions. These were as follows. (1) Anxiety due to the high-risk nature of the procedure and the uncertain outcome in relation to negative experiences by neighbors. (2) The potential harm of procedure-related issues such as general anesthesia, surgical positioning, the usage of extracorporeal membrane oxygenation and long time needed for the procedure. (3) Potential hazardous contamination in relation to the procedure, incision, catheter, ventilator, CVP, ductus arteriosus and chest tube insertion. (4) Possible failure of airway clearance functions, post operative GCS and nursing diagnoses such as E1M1VT and ventilator usage. Perioperative nursing was able to assist in alleviating the patient's physical pain and anxiety through preoperative inspection and care. These were done in conjunction with proper nursing instruction, correct monitoring of vital signs, the maintenance of hemodynamic stability, provision of physical nursing, the control of aseptic procedures, the maintenance of the right surgical positioning, the use of measures to instantly recovery body temperature and the sustaining of oxygen saturation.

並列關鍵字

perioperative nursing ； coronary artery bypass graft