照顧一位頰黏膜癌個案接受人工皮重建手術後之護理經驗

Nursing Care of a Patient With Buccal Squamous Cell Carcinoma After Artificial Skin Reconstruction Surgery

本文係照護一位5年前因心房中膈第一孔缺損（Ostium primum atrial septal defect）併僧帽瓣逆流曾行心房中膈修補及僧帽瓣修補術，此次因主動脈鈣化併僧帽瓣逆流，入院行第二次開心手術（主動脈瓣膜置換術）個案之護理經驗，護理期間為2012年8月1日至6日加護病房照護，經由直接照護、訪談、觀察及查閱病歷方式完成資料收集與評估，運用羅氏適應模式，確立個案健康問題為低效性呼吸型態、急性疼痛、焦慮等。以主動關懷、傾聽方式，提供個案相關資訊並協助早期下床、深呼吸和咳嗽刺激等護理措施改善呼吸道併發症；利用轉移對疼痛之注意力、按摩、換藥前提供塗擦局部麻醉藥膏，以減少肌肉緊張引發牽扯，減輕個案疼痛；藉正向經驗學習克服先前不良經驗導致之恐懼，進而減輕個案內心焦慮，改善術後身心調適問題，順利轉出加護病房。建議護理人員與個案互動時，多傾聽和關懷，深入了解個案心理層面之疑惑與焦慮，方能適時提供資訊，減少個案對手術之負面觀感。希望藉此個案之護理經驗，提出護理人員於日後照護二次心臟手術患者個案之參考。

The purpose of this report is to share the experience of caring for a patient who underwent　a second heart surgery for aortic valve replacement with a history of previous atrial septal defect (ASD) repair. The data were collected through actual care, observation, conversation, chart review, and by using Roy's adaptive model. The diagnosis included an ineffective breathing pattern and acute pain and anxiety. With empathic listening, we provided mental support, breathing skills, methods of attention transfer, and massages and local ointments to encourage early ambulation, prevent respiratory complication, and relieve postoperative pain. Positive experiences help patients to overcome fear, anxiety, and the negative memories of cardiac surgery. In this paper, we report the experience and provide a reference for caring for such patients in the future.