一位馬凡氏症病人接受主動脈剝離手術之護理經驗

Nursing Experience of Caring a Marfan Patient Undergoing Aortic Dissection Surgery

主動脈剝離是危及生命的疾病，若不及時治療，極具高死亡率，本文探討一位馬凡氏症候群病人接受主動脈剝離手術之護理經驗，護理期間自2018年11月29日至2018年12月22日。運用Gordon 十一項健康型態評估，以觀察、會談、身體評估及病歷查閱等方式，發現個案有以下之護理問題：(1) 活動無耐力、(2) 焦慮及(3) 潛在危險性感染。筆者透過治療性雙向溝通與個案建立良好護病關係，與個案、物理治療師及呼吸治療師共同討論心肺復健運動計畫，增加肺擴張及呼吸活動耐受性，運用六分鐘步行訓練及RPE 評估量表，讓個案能看見自己的進步空間，增加信心，使其能盡早恢復生活功能；在治療過程中，提供對疾病處置相關認知，能瞭解治療過程，並教導返家自我照顧技巧，鼓勵及邀請家人陪伴與學習，希望藉由家庭系統支持，進而減輕焦慮程度。願能透過此次的整體性護理經驗分享，提供日後醫護人員照顧類似病人之參考。

Aortic dissection is a life-threatening condition with a high death rate. This article described the nursing experience of caring a Marfan syndrome patient undergoing aortic dissection surgery. Nursing period was from November 29 to December 22, 2018. According to the Gordon 11 Function Health Patterns, data were collected, through observations, interviews, physical assessments, and review of medical records. The major nursing problems included: (1) activity intolerance, (2) anxiety, and (3) risk of infection. By establishing a good nursing-patient relationship, we discussed cardiopulmonary rehabilitation exercise plan with the patient. We also communicated with physiotherapists and respiratory therapists, aiming to assist the patient to improve pulmonary fuction and exercise tolerance. Through a six-minute walk test and rating of perceived exertion (RPE) scale, we improved the patient’s confidence and motivated him to participate in self-care training. We encouraged family members learn to provide psychological support to alleviate his anxiety. The article provides nursing staff with a reference for caring patients with Marfan Syndrome.