一位主動脈弓動脈瘤術後併發食道氣管瘻管重症個案之護理經驗

A Postoperative Nursing Experience of an ICU Patient with Aortic Arch Aneurysm Complicated with Esophageal-Tracheal Fistula

本報告主要是描述護理師藉由關懷溝通及跨團隊合作，協助主動脈弓動脈瘤併發食道氣管瘻管的69歲個案及家屬共同面對接受手術或安寧照護的護理經驗。護理期間為2013年6月13日至8月17日，整體性評估個案生理、心理、社會和靈性層面，以觀察、傾聽、筆談與會談察覺需求，進行主客觀資料收集，發現其因術後併發症導致病情變差，當醫師建議需再次行食道與氣管修補或肺葉切除術時，出現拒絕手術及面對死亡焦慮與無奈情緒，然家屬因不捨放手猶豫無法決策。於照護過程藉由關懷與個案及家屬建立互信，代言溝通並介入安寧共照，使其情緒舒緩，全家達成共識，個案獲得善終。期望此照護分享能提昇護理師重症安寧照護能力及重視病人自主決策權。

This case report described the nursing experience of 69-year-old male patient in ICU who had an aortic arch aneurysm complicated with esophageal-tracheal fistula, and the interdisciplinary collaboration in assisting the patient and family to agree to surgery or palliative care. The nursing period lasted from June 13 to August 17, 2013. A comprehensive evaluation was conducted to assess the patient’s physical, psychological, social and spiritual conditions. Objective and subjective data were collected, and the patient’s needs were identified, via observation, listening, written discussion, and interviews. According to the nursing diagnosis, the patient exhibited death anxiety and helplessness resulted from the deteriorating health conditions due to postoperative complications. When recommended by his physician to receive esophageal and tracheal repair or lobectomy, the patient refused surgery. The family’s attachment to the patient resulted in hesitation and indecisiveness. During the nursing period, the author established mutual trust with the patient and family through active care, facilitated communication between the patient and family, and intervened in the palliative care. As result, the family reached consensus and followed the patient’s wishes to the end. We hope to share this nursing experience to promote the terminal palliative care and bring awareness to patients’ right to autonomous decision making.