運用團隊合作照護一位因敗血症產婦胎死腹中加護病房護理經驗

A Nursing Experience of Applying Teamwork in the Intensive Care Unit to Caring for a Pregnant Woman with Stillbirth Caused by Sepsis

周家葦(Chia-Wei Chou) ； 曾雅燕(Ya-Yen Tseng) ； 胡憶芳(Yi-Fang Hu) ； 柯君樺(Chun-Hua Ko)

《弘光學報》 85期 (2020/03) Pp. 47-58

https://doi.org/10.6615/HAR.202003_(85).0004

摘要

本文描述照顧一位因敗血症死胎的孕婦，於妊娠35週時因感染海洋弧菌引發急性闌尾炎及死胎個案，過程經歷了敗血症重症照護、術後傷口的不適及失去胎兒的哀傷照護歷程。護理期間為2016年8月25日至2016年9月3日，運用生理、心理、社會、靈性、發展等五全評估，經由對個案身體評估及會談、傾聽、從旁觀察收集之資料再與醫療團隊討論後，確立三項護理問題：潛在危險性休克／與細菌感染致敗血症有關、急性疼痛／與子宮收縮痛、術後傷口有關、哀傷／與失去胎兒有關。護理過程在維持敗血症的生命徵象，對於失去胎兒給予心理支持及照護，傾聽感受並給予個案安全、信任的感覺，應用護理過程中給予鼓勵、提供個別性及整體性之照護，且偕同內科重症、外科、產科及社工專業人員與家屬跨團隊合作，主動聯絡社工給予心理慰藉，協助個案早日度過哀傷的衝擊，希望藉此照護經驗能與護理同仁一同分享。

關鍵字

團隊合作照護 ； 敗血症 ； 胎死腹中

並列摘要

This article describes the intensive care experience of a case of sepsis and stillbirth in a pregnant woman who experienced acute appendicitis caused by an Vibrio vulnificus infection at 35 weeks of pregnancy, and suffered from the grief of losing the baby, the discomfort of the postoperative wound, and sepsis. The nursing period was from August 25, 2016 to September 3, 2016. Three nursing issues were raised after a comprehensive evaluation of the physiological, psychological, social, spiritual, and developmental aspects, data collection by physical assessment, interviews, listening, and observation, and follow-up discussions with the medical team. Firstly, the potentially threatening shock was related to sepsis caused by bacterial infection, secondly, the acute pain was related to uterine contraction pain and the postoperative wound, and lastly, the sadness was related to the loss of baby. The nursing procedure included maintaining the patient's vital signs during sepsis, providing psychological support and care for the loss of the baby, listening to the patient's feelings, and giving the patient a sense of safety and trust. Encouragement, and individualized and holistic care were provided throughout the nursing process. We also carried out cross-team cooperation with the intensive care division of the internal medicine department, the department of surgery, the department of obstetrics, professional social workers, and family members, and assisted in contacting social workers to provide psychological comfort. The patient pulled through the impact of grief quite early. We hope to share this experience with nursing peers.

並列關鍵字

Vibrio vulnificus ； sepsis ； stillbirth

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