一位經腹腔鏡行胃繞道術患者之手術全期護理經驗

An Experience of Caring for a Patient with Laparoscopic Gastric Bypass

本文主要探討一位32歲肥胖合併糖尿病患者（但BMI = 36 kg/m^2）經腹腔鏡行胃繞道術之手術全期護理照護的過程。護理期間自2010年9月14日至17日，以Gordon十一項功能性健康型態評估，藉由觀察、會談、病史與身體評估收集資料，發現個案手術前面臨焦慮、手術中存有潛在危險性傷害、與術後傷口疼痛及知識尋求行為等健康問題。臨床中發現個案在住院手術過程中最在意術後是否能有效控制體重，以及其身體健康狀況是否有改善，故引發筆者寫此篇報告的動機。整個照護過程中，藉由手術前訪視，利用電腦多媒體簡介開刀房環境，說明手術前、後注意事項，適時給予關懷，介紹成功案例增加信心，以降低焦慮感；術中予以加蓋棉被、適當保護措施、確實對點器械，及注重無菌原則，以防潛在危險性傷害；術後運用轉移注意力技巧、冰敷傷口，減輕疼痛並提供飲食照護，降低腸胃不適。建議未來能建立一套有效的個案管理模式，解決其面臨的各項護理問題，落實手術全期護理，使接受手術之個案，能獲得持續性、整體性的照護，讓個案在手術期間可以得到高品質的護理。藉此個案護理經驗，提供給日後照顧此類病患之手術室護理人員做參考。

This article describes a perioperative nursing experience of caring for a 32-year-old obese diabetic patient with a BMI of 36. The patient underwent the surgery for laparoscopic gastric bypass. The nursing period was from September 14 to 17, 2010. With Gordon's 11 functional health patterns tool for assessment, data were collected through observation, interviews, medical history reviews, and physical examination. Based on data analysis, the patient's health problems included preoperative anxiety, high risk of surgical injury during the perioperative period, pain from surgical incision, and lack of knowledge about post-operative care. The patient's concern about effective control of body weight and health improvement after surgery motivated the author to initiate this research report. During the entire nursing care process, the author briefly introduced the environment of the operating room through multi-media, instructed what the patient needed to know before and after the surgeries, and provided adequate support. The author presented previous successful cases to build the patient's confidence in surgery and lower the patient's anxiety. The care interventions during the perioperative period included keeping the patient warm, providing adequate protection, counting correctly surgical instruments, and watching for sterile procedures to prevent potential risk of infection. The author offered distraction skills, applied ice packs to the incision for pain relief, and provided diet instruction to lower gastrointestinal discomfort during the post-operative period. Recommendations for the future are to establish an effective case management model, resolve various nursing problems that the patient faces, and thoroughly implement nursing interventions from pre-to post-surgery for continued and integrated high quality of nursing care. We hope that this article can be shared with other operating room nurses as a reference while caring for patients in similar situations.