照護一位行冠狀動脈繞道手術後病人之護理經驗

Care of Patient after a Coronary Artery Bypass Surgery Nursing Experience

冠狀動脈繞道手術為冠狀動脈疾病的重要治療方式之一。本文主要在探討一位行冠狀動脈繞道手術後病人的護理經驗，筆者於2010年11月26日至2010年12月5日護理期間，運用Gordon十一項健康功能型態評估，以觀察、會談、傾聽等方式蒐集及分析資料，於護理過程中發現主要健康問題有疼痛、活動無耐力及焦慮等，在疼痛方面提供非藥物性處置，如傾聽其感受、教導放鬆技巧、維持舒適臥位、執行減壓技巧、提供安靜、舒適環境等；在活動無耐力方面提供有系統的復健計畫，包括規律的運動訓練、衛生教育實施及諮商，進而順利進入復原階段；最後則運用多層面之護理措施，藉由家屬給予正向的鼓勵及支持，減輕焦慮不安、對於術後的復原有信心，於住院期間有正向的壓力調適，以回復正常生活及功能。期望藉此護理經驗之分享，能提供臨床醫護人員照護冠狀動脈繞道手術後病人的參考。

Coronary artery bypass surgery is one of the important treatments of coronary artery diseases. Patients might have problems with physical, psychological, and activity tolerance after cardiac surgery. This article mainly discusses the nursing experience for taking care of a patient after the coronary artery bypass surgery. During the nursing period from 26th October, 2010 to 5th December, 2010, the author determined the primary nursing problems during the nursing process including pain, activity intolerance and anxiety, by using the Gordon Eleven Functional Health Patterns Assessment, which is based on observing, talking, and listening for data collection and analysis. According to problems mentioned previously, the author provided non-pharmaceutical treatment modalities for the pain, which are listening to the feelings of the patient, teaching skills for relaxation, maintaining a comfortable lying position, performing cognitive stress-decreasing skills, and providing a quiet and comfortable environment. For activity intolerance, the author provided the patient with a systematic rehabilitation program, including regular exercise training, implementing hygiene education and consulting procedure with the patient, and then smoothly entering into a recovery phase. Finally, multi-level nursing care measures for the last part were used, by giving positive encouragement and support from family members to reduce the patient's anxiety. This enabled the patient to have confidence during the post-op (post-operation) recovery. The patient had positive stress adjustment thereby decreasing the anxiety level and returning to good life. With the sharing of this caring experience, the author hopes to provide a reference for nursing patients after coronary artery bypass surgery for clinical staff.