一位接受冠狀動脈繞道手術病人合併肺炎之護理經驗

An Experience of Nursing a Patient Who Underwent a Coronary Artery Bypass Graft (CABG) Procedure and Pneumonia Complication

本文是探討一位接受冠狀動脈繞道手術病人合併肺炎之護理經驗，個案於接受心導管檢查後進入加護病房，因出現急性冠心症，呈現生命徵象不穩定，緊急施行冠狀動脈繞道手術。護理期間為2006年8月13日至8月20日，筆者運用Gordon十一項健康型態評估，以觀察、會談、傾聽等方式蒐集及分析資料，並於護理過程中發現個案有心肺組織灌流改變、呼吸道清除功能失效及焦慮等健康問題。針對個案上述健康問題，在心肺組織灌流改變方面嚴密監測生命徵象，提供生理照護以降低肺水腫引起之症狀及避免心臟衰竭之產生；在呼吸道清除功能失效方面教導個案正確呼吸及咳嗽技巧，提供適當的胸腔物理治療，減輕術後肺部合併症，如痰液堆積及肺部擴張不全等，進而順利拔管；最後則運用多層面之護理措施，藉由家屬之關懷、陪伴與支持，讓個案對於術後的復原有信心，使個案住院期間有正向的壓力調適，並減輕焦慮程度，終讓個案能順利轉出加護病房。

This case study reported the nursing experience of caring a patient who underwent a coronary artery bypass graft (CABG) complicated with pneumonia due to acute coronary syndrom after angiography. During care of this patient from August 13, 2006 to August 20, 2006, using Gordon health assessment approach, observation, interviewing, and listening, the author disclosed that the patient had problems of ineffective tissue perfusion, specify ineffective airway clearance, and anxiety. Due to the above health problems, the author closely monitored vital signs and provided health care to reduce the symptoms of pulmonary edema and to prevent heart failure. As to the dysfunction of airway clearance, the author taught the patient the skills of breathing and coughing, and provided appropriate physical therapy to alleviate lung complications such as sputum accumulation and bronchioatlectasis for the removal of intubation. By using a multi-aspect nursing approach and support of his family, the patient felt confident in recovery and successfully being discharged from the ICU.