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照顧一位患有子宮肌瘤產婦併發產後出血之急診護理經驗

The Nursing Experience of a Postpartum Woman with Uterine Who was Complicated with Postpartum Hemorrhage

摘要


本篇敘述一位32歲患有子宮肌瘤的產婦,於剖腹產後造成產後大出血進而行子宮切除術之護理經驗,護理期間為2015年7月4日4點42分至6點5分,運用Gordon十一項功能性健康型態為評估工具,確認護理問題為:體液容積缺失/與產後出血有關、急性疼痛/與剖腹產及子宮收縮有關、焦慮/與產後出血及可能手術有關。護理過程中發現個案產後尚未感受到迎接新生命的喜悅,卻面臨子宮收縮不良造成出血量多需行子宮摘除,甚至休克,生命備受威脅,還需擔心手術的風險、內心產生極大的焦慮,筆者運用團隊合作力量,在短時間內穩定生命徵象,主動提供手術相關正確資訊,並陪同醫師詳細解說病情及手術的過程與重要性,解除個案及案夫的疑慮,使其瞭解手術治療對此急症的必要性且減緩焦慮,於知情同意後盡早施行手術。筆者同為女性,在照護過程中更能感同身受,運用關懷、陪伴及鼓勵,給予個案信心與力量,使其相信醫療團隊,勇敢接受治療,化險為夷,故藉此成功照護經驗的分享,提供第一線醫療團隊參考,亦建議急診人員在面對類似緊急個案時,可成立危急病人處理團隊,使在最短的時間內搶救並穩定病人生命,進而提升照護品質。

並列摘要


It's about the nursing experience that a 32-year-old pregnant woman with uterine fibroids who was bleeding after caesarean section. The care session was from 04:02 am. to 06:05 am. on July 4th, 2015. The Gordon's 11 Functional Health Patterns was the evaluation tool we used, and the care problems confirmed were: the loss of fluid balance/ related to Postpartum hemorrhage; acute pain/ related to caesarean section and the uterine contraction; anxiety/ related to postpartum hemorrhage and possible surgeries. During the process of care, the case was found that not being excited with the newborn baby; instead, she faced the life threatening experience and severe anxiety due to the abundant postpartum hemorrhage that was caused by the failure of uterine contraction. We stabilized her life sign and reduced her anxiety through our correct surgical information and our teamwork ability. The patient awarded the necessities of the surgeries and agreed to get the operation as soon as possible. The writer is also a female, so she understands how the patient has been feeling while taking care of the patient. By using care, accompany and encouragement, giving confidence and power, the writer made the patient believe that the team and take the treatment. The writer provides the reference for the first line staff by the sharing of this successful caring experience; and also suggests that when the emergency staffs face similar urgent cases, they can establish a team dealing with emergency patients, saving and stabilizing patients' lives in the shortest time and promote the caring quality.

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