一位腹主動脈瘤破裂術後無力感之加護護理經驗

Intensive Care Nursing Experience of a Patient with Postoperative Feelings of Helplessness After Surgery for a Ruptured Abdominal Aortic Aneurysm

本文敘述一位罹患腎下型腹主動脈瘤破裂個案術後入住加護病房照護經驗。因緊急手術，術後面臨生理的不適及術後進入陌生且封閉的加護病房，且因應COVID-19疫情醫院陪／探病管理措施限制家屬到院探視，而產生無力感情緒等不適護理問題，引發筆者對腹主動脈瘤破裂術後病人面對生理、心理探討動機，進而協助個案渡過術後急性期的生理不適及心理上的無力感。照護期間2021年6月11日至6月19日，筆者以直接照護、會談、觀察及查閱病歷等方式收集資料，運用羅氏適應模式的第一層次及第二層次評估方式，收集主客觀資料並分析內外刺激源，確立呼吸道清除功能失效、腎組織灌流失效、無力感三個主要護理問題。護理期間筆者與個案建立良好的護病關係，運用團隊資源偕同呼吸治療師及物理治療師共同介入，提供支持、照護和正向回饋，使個案能面對疾病的治療。筆者期望藉由此照護經驗分享，提供未來護理人員在臨床照護此類病人之參考，以提升護理專業能力。

This article describes the nursing experience of a patient with a ruptured infrarenal abdominal aortic aneurysm who was admitted to the intensive care unit (ICU) for postoperative care. As a result of the emergency surgery, the patient experienced postoperative physical discomfort and an unfamiliar and isolated ICU. Additionally, because of the COVID-19 pandemic, the hospital restricted visits from family members, leading to nursing-related issues such as feelings of helplessness and postoperative acute physiological discomfort. These nursing-related issues prompted the author to discuss the patient’s physical and psychological challenges following the surgery to assist the patient in coping with them. During the nursing period from June 11 to 19, 2021, the author collected data through direct care, conversations, observations, and a review of medical records. Using the first and second levels of Roy’s Adaptation Model, subjective and objective data were collected, and internal and external stimuli were analyzed. The author identified three main nursing-related problems: ineffective airway clearance, ineffective renal tissue perfusion, and feelings of helplessness. During the nursing period, the author established a good nurse-patient relationship with the patient, utilized team resources, and worked together with respiratory therapists and physical therapists to provide support, care, and positive feedback, helping the patient navigate through the course of disease treatment. The author hopes to share this nursing experience with future nursing professionals in the clinical care of similar patients to enhance their professional nursing abilities.