一位幼兒期心室中膈缺損修補術後加護護理經驗

An Intensive Care Experience of a Toddler with Ventricular Septal Defect after Surgery

本文探討一位幼兒期心室中膈缺損個案，接受心室中隔缺損修補開心術後之加護護理經驗，護理期間為2018年4月1日至2018年4月11日，藉由直接照護、身體評估、觀察、溝通會談等方式及運用Gordon十一項功能性健康型態評估表為工具，進行整體性評估，發現護理問題包括：低效性呼吸型態、疼痛、焦慮及照護者角色緊張等問題。在照護過程中運用個案熟悉物品、轉移注意力，設計符合個案發展之治療性遊戲，順利與個案建立信任關係，減緩術後的生理不適及分離焦慮。幫助案母面對個案術後問題，提供照護相關資訊及鼓勵參與照護計畫，增加其信心並緩解緊張情緒，協助個案順利返家照顧。進行衛教過程中，發現案母因過度焦慮而無法專注學習，故建議加護病房可增設海報及多媒體教材運用於衛教中，讓照顧者反覆學習，以提升衛教成效。

This study aims to share a nursing care experience of a toddler with ventricular septal defect after surgery based on Gordon's 11 Function Health Patters from April 1 to 11, 2018. A comprehensive evaluation was conducted by direct care, physical assessment, observation, and in depth interviews. Nursing care problems were found, including ineffective breathing pattern, pain, anxiety and caregiver role strain. During nursing care, a well-designed therapeutic play program was used to shift the client's attention by using his familiar objects, build trust with the client, relieve post-operative physical discomfort and alleviate separation anxiety. Related caring information was provided, and the caregiver was encouraged to participate in the caring program to increase her confidence and relieve her strain when caring the client at home. The mother was found to be too anxious to focus on learning, so it is suggested that posters were posted in PICU, and audiovisual materials are included in hygiene education program for care-givers to enhance education effectiveness.