一位急性心肌梗塞病患行冠狀動脈繞道手術之手術全期護理經驗

Perioperative Nursing Experience on a Patient with Acute Myocardial Infarction Undergoing Coronary Artery Bypass Grafting Surgery

本文描述一位急性心肌梗塞病患行冠狀動脈繞道手術之手術全期護理經驗，照顧期間2009年11月26日至2009年12月8日藉由傾聽、觀察、會談、查閱病歷資料等方式，運用Gordon十一項健康功能型態評估從手術前期、中期、後期進行資料收集，發現個案術前焦慮、術中潛在危險性體溫不平衡及潛在危險性手術情境傷害、術後知識缺失等健康問題。筆者藉由手術全期護理師角色透過術前訪視提供手術相關訊息緩解個案焦慮，術中依照手術室標準流程提供安全的防護措施預防潛在危險性傷害，術後與醫療團隊共同合作提供早期出院準備護理指導，使病患及家屬學習返家自我照顧能力，並於出院後恢復日常生活，維持良好生活品質。將此護理經驗與護理同仁分享，以提供手術室護理人員日後照護此類病患之手術全期參考。This case study explores perioperative nursing experience on a patient with acute myocardial infarction undergoing coronary artery bypass grafting surgery. During the period from November 26, 2009 to December 8, 2009, the author collected data from preoperative, intraoperative, and postoperative nursing care through observations, interviews, and chart reviews using the Gordon's Functional Health Pattern Assessment tool. The patient's nursing problems included anxiety during the preoperative phase, risk for imbalanced body temperature and risk for perioperative-positioning injury and during the intraoperative phase, and deficient knowledge during the postoperative phase. In the preoperative visit, we provided surgery-related information to alleviate the patient's anxiety. During the operation, we followed the standard operation procedure to provide safe and protection intervention to prevent risk of injury. During the post operation, we provided early discharge planning via medical team cooperation to educate the patient and family self-care skills as well as maintain good quality of life after discharge. We hoped that this nursing experience can serve as a reference to other operation nursing staffs in clinical practice.