照顧一位罹患心肌炎青少年的重症護理經驗

A Critical Nursing Experience of Caring for an Adolescent Patient with Myocarditis

柯儀芳(Yi-Fang Ko)

《長庚護理》 29卷3期 (2018/09) Pp. 491-501

https://doi.org/10.6386/CGN.201809_29(3).0014

摘要

本文主要描述一位罹患急性心肌炎病患，放置心肺容積監視器（pulse-induced contour cardiac output, PiCCO）監測及強心藥物使用照護經驗，護理期間自2015年12月21日至2015年12月24日，運用治療性關係、觀察、會談、病歷查閱進行資料收集，以Gordon十一項健康功能型態評估及分析，確立護理問題有心輸出量減少、睡眠型態紊亂及焦慮等。個案於加護病房期間因為疾病急遽變化，感到生命受威脅，個案情緒顯焦慮、不安並有哭泣之行為，故引發筆者探討此個案之動機。筆者以關懷的態度傾聽心理感受，建立良好護病關係後，鼓勵表達心中疑問，協助心理調適，運用圖畫說明、鼓勵、音樂療法等，以減輕個案因對疾病不了解所產生的焦慮，主動提供治療訊息和緩解個案生理不適狀況，避免中斷夜間睡眠，提升睡眠品質。在醫療團隊積極治療下，個案得於身心理症狀改善後，終能順利移除強心藥物，並康復轉至普通病房。本文藉由護理照護經驗之分享，提供臨床護理人員參考，祈能發揮護理獨特功能，讓護理專業服務品質更為提升。

關鍵字

心肌炎 ； 心肺容積監視器 ； 護理

並列摘要

This paper described the nursing experience of caring for a patient with acute myocarditis who used the pulse-induced contour cardiac out-put monitoring (PiCCO) and supported by inotropic agents. During the nursing care period (from 12/21/2015 to 12/24/2015), data were collected through observation, interview, and review of medical records, after es-tablishing caring relationship with the patient. By applying the Gordon's 11 functional health patterns assessment tool, the author confirmed that the patient had the following problem: decreased cardiac output, sleep pattern disturbance, and anxiety. The condition progressive rapidly in the intensive care unit. The patient was under life-threatening status, leading to emotional symptoms of anxiety, disturbance, and crying behavior. After listening to the patient expressed his psychological feelings with a caring attitude and establishing a good nursing relationship with the patient, the author encouraged the patient to express his doubt in mind, assisted the patient adjust psychologically, used pictorial instructions to encourage the patient, and offered music therapy to alleviate his anxiety caused by the unknown development of disease. The author took the initiative to provide treatment information and alleviated the physical discomfort to reduce nighttime sleep interruption so that the sleep quality could be improved. Inotropic agents were gradually reduced from the treatment plan. The patient recovered and was then transferred to the ordinary ward after receiving intensive treatment from medical team. The nursing experience highlights the significant function of nursing care that is essential in promoting the quality of care.

並列關鍵字

myocarditis ； pulse-induced contour cardiac output ； nursing

參考文獻

王德原、王秀琦、翁淑菁、章偉浩、陳瓏元、羅吉方(2010)。國人使用人免疫球蛋白製劑抗體保護力價之評估研究。食品藥物研究年報。1，172-181。

王俐潔、王桂芸(2010)。失眠的臨床評估及護理處置。護理雜誌。57(2)，105-109。

白筱雯、宋怡憓、李彩緣(2012)。照護一位心臟衰竭個案之護理經驗。若瑟醫護雜誌。6(1)，107-118。

林姵妘、毛瑛茹(2013)。照顧一位克服對血液透析焦慮個案之護理經驗。長庚護理。24(3)，307-316。

王筱珮、林珍瑋(2016)。重症單位血液動力學監測介紹。護理雜誌。63(1)，117-124。