運用Orem理論於一位行洛斯手術病患之手術全期護理

Applying Orem's Theory in Perioperative Nursing to a Patient with Ross Operation

本篇個案報告主要描寫照護一位罹患風濕性心臟病的病人，行Ross手術後3年，因主動脈瓣逆流復發進而接受二度開心手術之全期護理經驗。筆者於90年5月13日～90年5月26日期間，藉由觀察、訪談及應用Orem理論評估等技巧收集資料、確立問題。過程中發現，手術前個案所面臨的問題：焦慮；手術中：潛在危險性手術期間擺位之傷害、體溫過低；手術後：潛在危險性體液容積缺失、知識缺失。在整個照護過程中，運用Orem護理系統理論在術前提供病患支持教育性的護理措施，增加個案對手術的認知及因應能力，減輕其焦慮，使其有信心的接受手術；術中個案因麻醉自我照顧能力恢復，提供部分代償性護理；待出院做準備時又提供支持與教育性護理，促進其日後自照顧能力。藉此提昇護理服務品質，使個案獲得持續性與整體性的照護。

This case report describes the perioperative nursing of a patient who had previously undergone the Ross operation for rheumatic heart disease and who received renewed cardiac surgery following recurrence of the disease after three years. During May 13 to May 26, 2001, Orem's self-care deficit theory was used to assess the problems__anxiety, risk for perioperative positioning injury, hypothermia, risk for fluid volume deficit, and knowledge deficit__and to provide supportive-educative nursing in the preoperative phase, wholly compensatory nursing in intraoperative phase, and partially compensatory and supportive-educative nursing in the postoperative phase. Through the practice of perioperative nursing, the patient's understanding of the surgery was increased and his anxiety was reduced. The patient received the surgery with confidence, came through the surgery smoothly, and obtained the ability of self-care after discharge. The study is expected to advance the quality of nursing and provide nursing activities to the patient continuously and completely.