一位行經口達文西甲狀腺切除病人之手術全期護理經驗

Perioperative nursing experience of caring a patient undergoing transoral robotic thyroidectomy

本文描述一位年輕女性罹患甲狀腺癌行經口達文西甲狀腺切除手術之護理經驗。於2019年5月4日至5月9日護理期間，藉由觀察、傾聽、會談、查閱病歷及身體評估等方式蒐集資料，運用手術全期照護模式為指引，進行整體性評估，確立病人於手術前期因對手術過程、結果及相關認知模糊而產生焦慮，中期因麻醉制動及擺位具有潛在性手術情境傷害，後期則有疼痛之健康問題。護理過程中，於術前訪視運用傾聽及同理心鼓勵病人表達感受，利用多媒體介紹手術室環境及達文西系統，詳細說明手術及神經探測器之相關資訊，以釐清病人疑惑降低其焦慮。術中依標準作業流程維持正確擺位，以甲狀腺頭枕、脂肪減壓墊及棉墊提供適當保護措施，避免病人因擺位及機械手臂運作造成損傷；提供適當保暖及減少不必要之曝露，預防病人術中低體溫；正確計數器械、紗布及縫針，避免異物遺留體內，防止潛在危險性傷害。術後教導病人傷口疼痛減輕方式及給予傷口照護衛教，以緩解病人術後疼痛。期盼藉此護理照護經驗之分享，提供手術室護理人員照護此類病人之參考。

"This article described the perioperative nursing experience of caring a young female patient with thyroid cancer undergoing transoral robotic thyroidectomy. During May 4-9, 2019, through observation, listening, consultation, and evaluation of clinical history and physical examination, a thorough surveillance of this patient was performed under the guidance of perioperative care model. We concluded that the patient had nursing issues, including preoperative anxious about operation and results, anesthesia related immobility and positioning during operation, and postoperative pain. During the nursing process, the author listened to and empathized the patient and encouraged her to speak out. The author used multimedia to explain to the patient about what the operation room looks like, how the operation goes, and the Da Vinci system. During operation, the patient was placed at standardized positioning. We used head positioning cushion, adipose tissue stress release cushion, and soft cushion to avoid the potential injuries during operation. We also maintained euthermia, counted the instruments, pads, and needles correctly during operation. After operation, we educated the patient about how to take care of the wound and methods to relieve pain. This peri-operative nursing experience could be a helpful reference for caring similar patients."