照顧一位無效性自我健康管理心衰竭個案之加護護理經驗

Nursing Experience of an Ineffective Self-Health Management Patent with Heart Failure in Intensive Care Unit

吳淑偵(Shu-Chen Wu) ； 廖默瑩(Mo-Ying Liao) ； 孫美華(Mei-Hua Sun)

《亞東學報》 35期 (2015/12) Pp. 11-20

摘要

本文旨在分享一位心衰竭個案，因無效性自我健康管理使心衰竭症狀惡化導致反覆入住加護病房的護理經驗，筆者於2012 年7 月2 日至7 月9 日照護過程中，運用觀察、傾聽及會談等方式收集資料，以Gordon 功能性健康型態為評估指引，發現個案的健康問題有心輸出量減低、氣體交換障礙、焦慮與無效性自我健康管理，經由維持血液動力學穩定減輕心臟負荷，提升個案的心輸出量；密切監測氧合狀況給予呼吸照護，改善個案呼吸困難情形；同理個案生命威脅的感受及提供關懷，讓家屬陪伴參與照護，以減輕個案的心理壓力；了解個案限水目標執行困難之處，提供具體的限水措施，協助個案學習體液管理知識與技能，提升個案體液自我管理的自信，幫助個案改善病情轉出加護病房。經由此個案之護理經驗，筆者建議反覆入加護病房之心衰竭病人，在生命徵象逐漸穩定時要與個案共同討論，擬定符合個案需求的照護計畫，持續追蹤心衰竭個案健康照護狀況，提升心衰竭個案之自我照護品質。

關鍵字

心衰竭 ； 心輸出量減低 ； 氣體交換障礙 ； 焦慮 ； 無效性自我健康管理

並列摘要

The purpose of this article was to describe the nursing experience of a heart failure patient suffering from the deterioration of heart condition due to ineffective self-health management and transferred to intensive care unit (ICU) several times after relapses. The author employed observation skills, listening skills and interviews to collect information from July 2nd to 9th in 2012, and adopted Gordon functional health patterns as the guidelines for evaluation. The patient’s health problems identified including decreased cardiac output, impaired gas exchange, anxiety, and ineffective self-health management. By keeping hemodynamics stable and monitoring the state of oxygenation, the patient’s cardiac output and respiratory condition was improved. Concerning about patient’s about patient’s life-threatening and psychological pressure, the author arranged to have his family members companied. Understand the patient who difficult reason for fluid restriction and provided specific measures to reduce water consumption, instructing the patient knowledge and skills about fluid management and enhancing the patient’s fluid self-management confident, so that he can move out of ICU. It is advised that subject should join in discussions about the most appropriate health care plan for the patients suffering relapses with heart failure when their vital signs are stabilized. The patients’ health care conditions shall be continuously tracked, so the quality of self-health management can be immensely improved.

並列關鍵字

Heart failure ； Decreased cardiac output ； Impaired gas exchange ； Anxiety ； Ineffective self-health management

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