- 期刊
一位心肌梗塞併發心因性休克個案面對死亡焦慮之加護經驗
Nursing Experience of a Patient facing Death Anxiety with Myocardial Infarction Complicated by Cardiogenic Shock
摘要
本文描述一位56歲男性初次罹患急性心肌梗塞併發心因性休克及呼吸衰竭，在加護病房期間使用主動脈氣球幫浦協助改善血液動力學不穩，面臨死亡焦慮之加護照護經驗。護理期間為2020年9月5日至9月15日，筆者藉由實際觀察、會談、查閱病歷等方式收集資料，運用Gordon十一項功能性健康型態為架構，確立個案有心輸出量減少、死亡焦慮及知識缺失等健康問題。針對上述護理問題提供個別性、整體性之護理計畫與措施，經由醫療處置、心肺復健及監測輸出入量等護理照護的介入，維持個案的心臟血流輸出功能，使個案成功脫離主動脈氣球幫浦及氣管內管，緩解生理不適；採用語言及非語言的溝通方式、運用同理心、情緒支持、家庭支持等措施，增加個案對治療的信心，緩解其心理焦慮；聯合營養科進行飲食衛教、評估戒菸意願及轉診家醫科門診，並會診復健科執行心肺復健運動，期望提升個案自我照護能力，減少疾病再發生率並提升生活品質，並順利轉出加護病房。期望藉此護理經驗，提供臨床護理同仁照顧心肌梗塞面對死亡焦慮病人之參考。
並列摘要
This case report describes a 56-year-old male diagnosed with acute myocardial infarction complicated by cardiogenic shock, respiratory failure and death anxiety. Patient used an intra-aortic balloon pump to improve his hemodynamic stability in the intensive care unit. The nursing care period from September 5 to 15, 2020 through observation, interviews, and medical record review. Evaluation assessment tool used Gordon's 11 functional health patterns model. Nursing interventions included (1) monitoring of input and output, (2) providing effective verbal and nonverbal communication, (3) applying empathy and emotional support to patient and family, (4) coordinating care with nutritionist and physical therapist for cardiac rehabilitation, and (5) referring to Family Medicine outpatient for smoking cessation. The author shared the key points in the care of myocardial infarction and anxiety for future reference.