照護一位主動脈剝離術後行氣管切開術產生無力感之護理經驗

Nursing Experience of Caring for A Patient Post Aortic Dissection with Tracheostomy Resulting in Feelings of Powerlessness

本文描述一位主動脈剝離接受緊急手術後，因面臨高危險疾病所帶來的死亡威脅，及術後突如其來的心、肺衰竭合併症，需行氣切手術壓力與長期臥床導致肢體無力、生活無法自理，使得生、心理面臨極大衝擊考驗之護理經驗。照護期間為2022年3月22日至4月14日，運用Gordon十一項健康功能型態評估，藉由病歷查閱、觀察、筆談、傾聽及身體評估等方式收集資料，確立個案有低效性呼吸型態、自我照顧能力不足、無力感等健康問題。照護期間提供個別性護理措施，維持呼吸道暢通，教導復健方式增加自我照顧能力，給予正向支持以降低負向情緒，鼓勵表達其感受，協助面對治療及疾病壓力，最終個案成功脫離氣切。期望藉此護理經驗，能做為日後照護此類個案之參考。

This article describes the nursing experience of a patient who underwent emergency surgery for aortic dissection but faced imminent threats of death due to high-risk comorbidities and sudden postoperative complications of heart and lung failure. The patient also experienced limb weakness and loss of self-care abilities due to the pressure of surgery and prolonged bed rest. This presented immense challenges to both physical and psychological aspects of care. The care period extended from March 22, 2022, to April 14, 2022. The Gordon 11 Functional Health Patterns were employed for health assessment. Data collection involved case review, observation, interviews, listening sessions, and physical assessments, which confirmed issues such as inefficient respiratory patterns, Self-care deficit, and feelings of powerlessness. Individualized nursing measures were implemented during the care period to maintain airway patency, teach rehabilitation techniques to enhance self-care abilities, provide positive support to mitigate negative emotions, encourage expression of feelings, and assist in coping with treatment and disease-related stress. Eventually, the patient successfully weaned off the ventilator. It is hoped that this nursing experience will serve as a reference for future care of similar cases.