一位行冠狀動脈繞道手術患者術後之護理經驗

Nursing Care for a Post Coronary Artery Bypass Graft Patient

本篇個案報告是敘述協助一位冠狀動脈繞道手術患者解決術後所引發生理、心理相關護理問題的過程，於照護期間（92.2.21-92.3.12）以Roy適應模式為評估指引，並運用觀察、會談及查閱病歷等技巧收集我，發現個案是經由家人勸說妥協接受開心手術，於術後首先面臨急性疼痛的情況，而且與過去手術經驗截然不同，表現消極且被動，而呈現出無力感的現象，且併有潛在危險性活動無耐力及皮膚完整性受損等健康問題；在護理過程中運用多層面之護理措施，並藉良好的支持系統鼓勵、陪伴，引導其抒發負現情緒感受，以正向態度面對此重大手術事件，進而增強其自我控制感。希望藉此護理經驗提供護理同仁照顧類似病患時，除了減輕術後之身體不適外，亦能重視並以同理心深入了解心理層面，以達廣泛之照護。

This case report describes the nursing care for a post-CABG patient. During the nursing period, observation, interview and reviews of medical chart were performed under the guidelines for Roy's model. This patient was persuaded to undergo surgery by her family, and suffered from acute pain that was different from any associated with previous operations. A passive and depressed attitude and a sense of helplessness were noted on the part of the patient, combined with a risk of activity intolerance and impaired skin integrity. The multiplex process of nursing was used to encourage the patient to take advantage of her strong support system, to express her negative feelings, to look at the bright side of this major surgery and to improve her self-control. The paper seeks to stress the importance of empathy concerning more than mere physical discomfort to achieve comprehensive care.