一位高齡產婦因胎兒異常需妊娠終止之手術全期護理

A Perioperative Nursing Experience of Advanced Maternal Termination for Fetal Abnormality

本文探討一位懷孕24週之高齡產婦，因產檢發現胎兒染色體異常，進行剖腹產妊娠終止之手術的護理經驗。照護時間為2020年4月6日至2020年4月10日，於術前訪視、術中陪伴觀察、術後訪視與個案會談、評估及病歷查閱等技巧，並運用Gordon十一項功能性健康型態評估，確認個案之護理問題有：1.哀傷／與失去胎兒有關；2.潛在危險性傷害／與手術情境，異物留置體內及手術電燒筆有關；3.急性疼痛／與手術傷口有關。針對其護理問題給予之護理重點是：1.陪伴傾聽，給予個別性的護理措施，並與家屬共同協助面對哀傷；2.提供安全的手術環境，預防病人造成傷害；3.減輕手術後傷口的疼痛度，以增加舒適感。對於妊娠終止而失去胎兒的產婦而言，除了生理上的照護之外，最重要的還有心理與靈性的照顧，如何針對心理層面提供支持，因而引發筆者之動機，由於住院天數短，無法觀察個案心理恢復狀況，建議以電訪繼續關懷個案。期望藉由此護理經驗，以提供手術室護理人員照護此類病人之參考。

This article discusses the nursing experience of 24 weeks pregnant women of advanced maternal age whom underwent caesarean section to terminate the pregnancy because of fetal chromosomal abnormalities found during prenatal examination. The care period was from April 6 to April 10, 2020. A comprehensive approach including preoperative visits, intraoperative companion observations, postoperative visits, case interviews, assessments, and medical record reviews was used. Additionally, several nursing issues were identified using Gordon's 11-Functional Health Patterns: 1. Grief history of fetal loss: 2. potential risks associated with surgical situations, retained foreign bodies, and the use of surgical electrocautery pens; 3. Acute pain arising from surgical wounds. The focus of the care given to this problem was as follows: 1. Accompanying and listening, implementing individualized nursing measures, and collaborating with family members to address grief; and 2. ensuring a safe surgical environment to prevent harm; and 3. Soothing postoperative pain to enhance comfort. Apart from the physical pain associated with terminating pregnancy, this article focuses on providing psychological and spiritual care. Owing to the short hospitalization period, long-term follow-up was conducted through telephone interviews. It is hoped that this nursing experience will serve as a reference for nursing staff in the operating room to take care of these patients.