一位心衰竭第三期病人之照護經驗

A Stage C Heart Failure Patient's Caring Experience

洪慧霞(Hui-Hsia Hung) ； 陳淑華(Shu-Hua Chen) ； 馬瑞菊(Jui-Chu Ma)

《領導護理》 20卷3期 (2019/09) Pp. 52-64

https://doi.org/10.29494/LN.201909_20(3).0005

摘要

本文係描述一位心衰竭第三期病人入住加護病房，以提供個別性護理活動，避免疾病惡化至第四期之護理經驗。護理期間為2016年3月25日至4月20日，藉由主動關懷、醫療訊息的提供、家屬會談、病歷查閱並運用Gordon十一項功能性健康評估、參考文獻等方式，確立健康問題為：體液容積過多（心臟疾病及攝食習慣不當導致體內水分滯留）、活動無耐力（低心輸出量導致氧氣供需不平衡）、焦慮（對於疾病本身的不確定感及擔心疾病惡化）。針對病人個別性需求，擬定相關護理計畫及措施，護理過程中，以矯正攝食習慣不當知能、適當限制水分及鹽分，減少體內水分堆積；有計畫的執行心臟復健運動，增強心臟活動耐力及功能，改善呼吸衰竭及肌肉無耐力情形並進行衛教活動及鼓勵正向思考、感受社會支持，緩解病人對疾病的焦慮感，終而讓心衰竭第三期避免惡化至第四期，日後得以轉至普通病房後順利返家。期望藉此照護經驗分享，提供個別性護理活動，幫助此類病人渡過身心的痛苦煎熬，使病人的身、心、靈層面都能獲得完整的照護。

關鍵字

心衰竭第三期 ； 照護經驗

並列摘要

This article narrates nursing experience from caring a patient with stage C heart failure admitted to the intensive care unit for individual care activities in order to avoid deterioration towards stage D. Nursing period was from March 25 to April 20 in 2016, conducted with initiative care; the provision of medical information; family communication; medical records and Gordon 11 functional health assessment application; reference literature, and so on. For the purpose of establishing health problems: Excessive body fluid volume; heart disease and inappropriate feeding habits led to in vivo water retention, activity of no endurance or low cardiac output led to oxygen supply and demand imbalance, anxiety about the disease itself and in regards disease deterioration. For the individual needs of each patients, the development of relevant care plans and measures, care process, correction of knowledge about inappropriate eating habits, appropriate consumption of water and salt, reduction of water accumulated in the body; a planned implementation of cardiac rehabilitation exercise, enhance cardiac endurance and function; improve respiratory failure, muscle endurance situation and health education activities as well as encourage positive thinking, social support feelings to ease the patient's sense of anxiety about the disease, and finally stop the third phase of heart failure progressing to the fourth phase. In the near future the patient can be transferred to the general ward after a smooth return home. From these valuable nursing experiences, the expectation of sharing is to provide individual ca re activities to guide such patients through the pain of physical and mental suffering, so that both patients' physical and mental level can be taken care thoroughly.

並列關鍵字

stage C heart failure ； care experience

參考文獻

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