照護一位冠狀動脈繞道術後患者之護理經驗

A Nursing Care Experience of a Patient Who Underwent a Coronary Artery Bypass Graft Procedure

本文為照護一位冠狀動脈繞道術後患者之護理經驗。個案有高血壓及糖尿病病史，面對術後疼痛、疾病照護感到焦慮，故引發筆者深入探討。護理期間自2020年4月11日至2020年4月15日，以Gordon十一項健康型態評估，藉由觀察、傾聽、與訪談，蒐集主客觀資料，確立護理問題有：低效性呼吸型態、急性疼痛及焦慮等三項。針對各項護理問題，擬定適合之護理計劃。低效性呼吸型態方面：教導深呼吸、咳嗽運動，介入肺部復健運動，以利肺部擴張，改善肺部合併症，進而成功脫離呼吸器；急性疼痛方面：教導緩解疼痛技巧、轉移注意力，使用連續性靜脈注射止痛藥，使個案疼痛指數降至2分；焦慮方面：適度陪伴及主動告知病情狀況，提供術後照護注意事項、教導放鬆肌肉技巧，使焦慮情形得以改善。未能參與術前準備和衛教，故建議成立心肺復健部門，於手術前協同物理療師進行訪視，共同擬定個別化運動目標及進度表，以提高生活品質、增強運動耐受性、預防和治療各種併發症。希望藉由此護理經驗，能提供臨床護理人員日後照護相關疾病個案時，給予更完整的護理過程，提高護理品質。

This article describes the nursing experience of caring for a patient after coronary artery bypass surgery. The patient has hypertension and diabetes history, to face postoperative wounds pain, and complications this felt anxious. Therefore, led to the motivation for this paper. The nursing period lasted from April 11th to 15th in 2020, applied Gordon's 11 Functional Health Patterns to collect data through observation, listening, interview, and identified health problems, including ineffective breathing pattern, acute pain, and anxiety. The author created a nursing plan targeted to the patient's health problems. Ineffective breathing pattern: We taught deep breathing, coughing and pulmonary rehabilitation exercise to enhance lung ventilation, reduce pulmonary complications and help successful weaning ventilator; acute pain: The author used non-pharmacological method, distraction and continuous pharmacological method to decrease patient’s pain score to 2; anxiety: With our active care and company consisted of informing the patient of the treatment direction, knowledge regarding postoperative care and relaxation techniques were taught, so the patient's anxiety were relieved. However, unable to participate in the preoperative preparation and education, so it's recommended to set up a cardiopulmonary rehabilitation department, to visit patient with the physical therapist and provide an individualized rehabilitation program before surgery, so as to improve quality of life, increase muscle endurance and reduce complications. By sharing this experience, the author hopes it can serve as a reference for clinic staff to provide appropriate care when caring for similar patients in the future.