- 期刊
一位心肌梗塞後心室中膈缺損病人之加護經驗
Nursing Experience of a Patient With Ventricular Septal Defect Post Myocardial Infarction in the Intensive Care Unit
摘要
本文講述一位心肌梗塞後心室中膈缺損的病人，因心因性休克接受體外循環氧合器及主動脈氣球幫浦治療之加護經驗，筆者於2020年4月11日至4月18日照護期間，藉由直接照護、病歷查閱、身體評估等方式收集資料，運用Gordon十一項功能健康型態進行整體性評估，確立病人有心輸出量減少、高危險性出血以及家庭因應能力失調等健康問題，因篇幅限制，選擇最重要的三項健康問題擬定護理措施。照護期間介入重症護理穩定血流動力學及監測出血合併症，並藉由醫病共享決策引導家屬們以病人為中心，探索病人的可能意願，最後決定簽立不施行心肺復甦術與撤除維生醫療同意書，與安寧共照師一同引導家屬向病人道愛、道謝、道歉與道別後執行安寧撤管，完成生死兩相安的善終照護。
並列摘要
This study reports the case of an 81-year-old woman with myocardial infarction complicated by cardiogenic shock in the intensive care unit. The woman received extracorporeal membrane oxygenation and an intra-aortic balloon pump. Data were collected from April 11 to April 18, 2020, using observations, interviews, medical records, and physical assessments. In the nursing process, Gordon's eleven functional health patterns were used to conduct a comprehensive evaluation of patient care and family health assessment. During the nursing period, three major health problems were identified: reduced cardiac output, a high risk of bleeding, and ineffective family coping. The study focuses on these three critical health problems and recommends corresponding nursing measures. The care outlined emphasizes maintaining hemodynamic stability and preventing complications, such as bleeding, in the cardiac intensive care unit. Shared decision-making was implemented and involved an interprofessional collaborative health-care team that guided the family to reach a consensus and provide mental support to the patient. The family signed a Do Not Resuscitate permit and opted for compassionate hospice extubation. The family were encouraged to express their love, gratitude, apologies, and farewell to the patient. This approach ultimately brought comfort to both the patient and the patient's family members.