一位三尖瓣閉鎖學齡期兒童於開心手術後之護理經驗

Nursing Experience of a School-Aged Child with Tricuspid Atresia Following Open-Heart Surgery

本文是探討一位三尖瓣閉鎖學齡期兒童於開心手術後住於加護病房之護理經驗。筆者利用Gordon 11項功能性健康型態為評估工具，經由觀察、會談、身體評估與病歷記錄等方式收集資料，確立個案的主要護理問題如下：(1)低效性呼吸型態，與心臟手術後、氣管內管留置、無法自咳及痰液黏稠有關；(2)舒適情況改變：疼痛，與正中胸骨切開手術傷口及氣管內管、胸管留置有關；(3)危險性感染，與手術傷口、引流管及各種導管裝置有關；(4)分離焦慮，與加護病房的陌生環境、與案母分離與害怕死亡有關。筆者和個案建立信任關係後，運用兒童溝通技巧、持續性關懷、適時陪伴支持與「無創傷性照護」理念來減輕術後疼痛及降低對醫療的恐懼，進而改善其退行性行為，提供整體性關懷照護來協助個案成功脫離呼吸器，期望藉此護理經驗的分享，能提供未來臨床照顧的參考指引。

This article reported nursing experience of a school-aged child with tricuspid atresia following open-heart surgery in PICU. During the nursing period, we collected data from interview, observation, physical assessment, and review of medical chart. The Gorden’s functional health assessment guide was used to identify health problem. The patient had four major nursing health problems as the followings: (1) Ineffective breathing pattern, related to open-heart surgery, endotracheal intubation unable to cough and sticky sputum; (2) Altered comfort: pain, related to operating wound from median sternotomy, endotracheal and chest tube drainage; (3) Risk for infection, related to operation wound, drainage tube and various tubing device; (4) Separation anxiety, related to unfamiliar environment in PICU, separation from her mother and fear for death. After building trust relationship, we utilized communication skills with the child, holistic caring, appropriately accompany, psychological support, and philosophy of “atraumatic care” to relieve surgical wound pain, and minimize her fear for medical treatment, furthermore, alleviate her regressive behaviors. We helped the child to wean the ventilator successfully. This case report provides nurses with a clinical reference for caring similar patients in the future.