一位冠狀動脈繞道手術後患者之護理經驗

The Nursing Experience of Caring for a Coronary Artery Bypass Grafting Post-operative Patient

本篇個案報告在探討一位冠狀動脈繞道手術患者術後所引發生理、心理護理問題之照護過程。筆者於2009年7月16日至8月10日照護期間，運用Gordon十一項功能性健康型態評估作為指引，經由身體評估、會談、觀察、傾聽及查閱病歷等技巧收集病史，發現個案於術後產生疼痛問題，影響執行心臟復健的意願，表現消極被動，確立個案有急性疼痛、低效性呼吸型態與無力感等護理問題。針對個案上述護理問題，於護理過程中提供疼痛控制方法、教導個案正確的深呼吸及咳嗽技巧、個別性給予漸進式的心臟復健，以促進心肺功能的恢復；藉由完整的支持系統鼓勵並引導其抒發負面情緒，以正面的心態迎接此手術事件，進而增強其內心自我控制感，配合參與心臟復健計劃，順利進入復原階段。希望藉由此護理經驗可提供有效的術後護理措施，作為護理人員提供冠狀動脈繞道手術後健康照護之參考。

This study describes the nursing experience of caring for a post-operative patient with coronary artery bypass graft surgery. The nursing care period was from July 16 to August 10, 2009. Data on medical history were collected by interviews, observation, listening, and medical record review and evaluated according to Gordon’s 11 functional health patterns assessment tool. We found that the patient’s willingness to execute cardiac rehabilitation was influenced by postoperative pain. The patient’s performance was negative and passive. It was confirmed that the patient suffered from nursing problems of acute pain, ineffective breathing patterns, and sense of powerlessness. In the nursing processes, the patient was provided with pain control methods, taught correct deep breathing and coughing skills, and was offered individual progressive cardiac rehabilitation to promote restoration of cardiopulmonary functions. With the encouragement and company of a complete support system, the patient was guided to express negative emotions, enabling the patient to face surgery with a more positive attitude. As a result, the practice further enhanced patient’s sense of self-control, facilitated active participation in the cardiac rehabilitation program, and allowed a smooth entry to the restoration stage. It was hoped that the nursing experience could offer effective postoperative nursing measures, and serve as reference for nursing staff to offer postoperative health care tp patients undergo coronary artery bypass graft surgery.