一位Bentall術後病患因肺部合併症再次入住加護病房之護理經驗

Nursing Experience of a Patient Who Underwent Bentall Procedure with Pulmonary Complication and Readmission to Intensive Care Unit

本文是在敘述照護一位老年人因主動脈瓣膜逆流併主動脈弓擴張行主動脈瓣膜置換及心血管重建Bentall手術，手術後發生肺部合併症之經驗。筆者護理期間為2015年10月11日至10月19日，經由直接照護、身體評估、查閱病歷及家屬會談收集評估資料，運用羅氏適應模式確定個案之健康問題為呼吸道清除功能失效、活動無耐力、無力感等問題。在護理時藉由跨團隊共同討論，教導呼吸運動、身體活動及胸腔物理治療，促進肺部擴張且讓痰液有效排出，改善活動耐力。而在面對個案無力感時，主動給予關懷，擔任個案與妻子之間溝通的橋梁，增加自主決策。希望藉由此個案之護理經驗，可做為護理人員於日後照護Bentall手術患者之參考。 This article describes the nursing experience of caring for an elderly patient who underwent aortic valve replacement and cardiovascular reconstruction with the Bentall procedure for aortic valve regurgitation and aortic arch dilatation and who experienced pulmonary complications after the operation. The nursing period was October 11th to 19th, 2015. Health problems were identified on the basis of the Roy adaptation model, with direct care, physical assessment, medical records, and family meetings used to collect assessment data. The health problems recognized were ineffective airway clearance, activity intolerance, and powerlessness. Team discussion, breathing exercises, physical activity, and chest physical therapy were used to increase lung expansion and effective expectoration in addition to increasing endurance activity. When the patient experienced powerlessness, the initiative to give care and serve as a bridge between the patient and his wife increased the effectiveness of the couple’s decision-making. This nursing experience is intended to provide a reference for nursing staff caring for patients who undergo the Bentall procedure.