一位主動脈變狹窄老年病患接受經導管主動脈辮膜置換及永久性心臟節律器放置治療之護理經驗

Nursing Experience Related to Caring for an Elderly Aortic Stenosis Patient with Transcatheter Aortic Valve and Permanent Pacemaker Implantations

本文描述一位主動脈瓣狹窄（aortic stenosis, AS）的老年病患接受經導管主動脈瓣膜置換（transcatheter aortic valve implantation, TAVI）及永久性心臟節律器放置治療的護理經驗，照護期間為2013無7月3日至2013無 7月15日，筆者以Gordon十一項功能性健康型態收集資料及分析，發現個案因主動脈瓣狹窄以及TAVI術後合併心臟傳導阻滯，因此有心輸出量減少健康問題，需放置永久性心臟節律器（permanent pacemaker, PPM），術後則有無力感及知識缺失（主動脈瓣狹窄老年病患接受TAVI及PPM治療後之居家生活相關注意事項）之健康問題。針對心輸出量減少的問題，提供了增加心輸出量護理措施，以減輕心臟工作負荷量，滿足身體所需之生命徵象；無力感問題方面，則藉由建立 良好護病關係，引導表達內心感受並鼓勵參 與照護活動，以增強個案對現況控制感、知識缺失（主動脈瓣狹窄老無病患接受TAVI 及PPM治療後之居家生活相關注意事項）部分，予教導抗凝血藥物服用之飲食及居家生活注意事項，以及PPM放置後之傷口護理與 返家後自我照護活動，以提升居家生活品質。 期望此TAVI術後照護經驗，能提供給日後臨床護理人員照護類似個案的參考與分享。

This article describes the nursing experience of caring an elderly aortic stenosis (AS) patient who received a transcatheter aortic valve replacement implantation (TAVI) and perma-nent pacemaker (PPM) implantation. The period of nursing care was from July 3, 2015 to July 15, 2013. The authors collected and assessed the patient's health problems accord-ing to the Gordon 11 Functional Health Patterns Method and identified nursing problems such as low cardiac output (due to AS and post-TAVI conduction disorders), powerlessness, and lack of knowledge about taking anticoagulants, wound care, and self-care at home. To manage low cardiac output, nursing interventions were applied to increase the cardiac output, reduce heart workload, and stabilize the vital signs to supply enough blood to the entire body. To treat powerlessness, a nurse-patient relationship was established to encourage the patient to express concern and personal feelings to enhance the patient's own sense of control over her life plans and confidence in her ability to manage her condition. Additionally, the patient was informed about diet and contraindications to anticoagu-lants, PPM wound care, and other related health education to promote quality of life. Finally, the author hoped this nursing experience can be used as a reference by nursing staff caring simi-lar client in the future.