- 期刊
一位放置植入式心律去顫器的病人之遠距照護經驗
Remote Telecare Experience for a Patient with an Implantable Cardioverter-defibrillator (ICD)
摘要
本文探討一位心臟衰竭合併冠狀動脈阻塞的病人，因心室心搏過速而安裝植入式心律去顫器之遠距照護經驗。照護期間自2019年5月2日至7月2日，以遠距個案管理師角色藉由電話追蹤、會談、觀察、查閱病歷記載及門診返診跟診等方式進行資料收集，運用Gordon 11項健康功能型態評估分析，確立個案有心輸出量減少、潛在危險性感染及焦慮等健康問題。運用個別性護理，提供相關的資訊，並主動傾聽、溝通、陪伴緩解因植入心律去顫器後的身心壓力，協助個案面對不可預期的電擊及學習術後傷口照護，逐漸接受並與體內的去顫器和平共處。建議臨床上除了定期醫師門診追蹤外，可透過個案管理師藉由持續且密切的監測與照護，期能早期發現心律不整或儀器功能問題，及時提供醫療處置，進而提升醫療照護效率與品質，同時能減少醫療、健保的支出。
並列摘要
This article discusses the care process for a patient with heart failure due to coronary artery obstruction. The patient was equipped with an implantable cardioverter defibrillator (ICD) for ventricular tachycardia from May 2 to July 2, 2019. The data collected were informed by telephone tracking, interviews, observations, retrieved medical records, outpatient visits, and follow-ups by remote case managers. Gordon's 11 functional health assessments were used to analyze the health problems associated with cardiac output reduction, potential infection risk, and anxiety. To alleviate the mental distress caused by defibrillator implantation, the patient was provided with individual care and relevant information combined with active listening and communication. As a result, case managers can help the patient mitigate unexpected electric shocks, learn postoperative wound care as well as gradually accept and peacefully interact with the body defibrillators. Thus, case managers can use continuous and close monitoring and care for the early detection of problems associated with arrhythmia or instrument functioning. Furthermore, case managers can provide timeous medical treatment and improve the efficiency and quality of medical care to reduce medical and health insurance expenditure.