年輕男性動靜脈畸形成功移除管路之護理經驗

Nursing Experience of Successful Removal of Tubes in a Male Patient with Arteriovenous Malforma

本文為探討年輕男性動靜脈畸形術後成功移除氣切及鼻胃管之護理經驗，護理期間自2020年9月14日至10月12日，以觀察、筆談及Gordon十一項功能性健康評估，確立健康問題有呼吸道功能清除失效、潛在危險性肺吸入及照顧者角色緊張。個案因動靜脈畸形破裂行開顱手術，術後困難脫離呼吸器行氣切手術且放置鼻胃管，對於非預期的健康改變，協同醫療團隊與個案及案父母共同擬定呼吸、吞嚥訓練及日常生活照護計畫，於執行計畫過程提供衛教單張、影片和示範教學，並搭配訓練評值表，過程予以正向回饋增強自信心，鼓勵案父母參與照護過程，提供可利用資源，減輕案父母照顧上的緊張焦慮感，並成功移除鼻胃管及氣切管路。此外，運用出院準備跨專業團隊會議共同評估個案返家後的照顧問題，予提供銜接照護資源，使返家後能獲得良好及持續性的健康照顧，期許此經驗能提供日後留置氣切及鼻胃管個案照護之參考。

This study investigated the nursing experience of a male patient with arteriovenous malformation who had tracheostomy and nasogastric tubes successfully removed postoperatively. Nursing care was provided from September 14 to October 12, 2020. The health problems identified through observation, written interview, and Gordon’s 11 functional health patterns were respiratory clearance failure, potentially dangerous pulmonary aspiration, and nervousness in caregivers. The patient underwent craniotomy because of arteriovenous malformation and rupture. Tracheotomy and nasogastric intubation were performed because of difficulty in weaning from the ventilator postoperatively. Following the unanticipated health condition changes, the medical team collaborated with the patient and parents to develop breathing and swallowing training and daily personal care plans. While implementing the plan, the health education leaflets, videos, and demonstrations were provided with training evaluation forms, positive feedback was provided during the self-confidence enhancement process, parents were encouraged to participate in the care process, and available resources were provided to reduce the parents’anxiety in providing care. Ultimately, the nasogastric and tracheostomy tubes were successfully removed. Additionally, a multidisciplinary team meeting was conducted to evaluate the problems with providing care after the patient was discharged and provide transitional care resources so that the patient could receive good and continuous healthcare after discharge. We hope that this experience can be a reference for future cases of indwelling tracheostomy and nasogastric tubes.