一位服用巴拉刈自殺病人的急診照護經驗

An Emergency Nursing Experience of a Patient Who Attempted Suicide by Paraquat Poisoning

劉淑娟(Shwu-Jiuan Liu) ； 郭嘉琪(Chia-Chi Kuo)

《新臺北護理期刊》 18卷1期 (2016/03) Pp. 113-123

https://doi.org/10.6540/NTJN.2016.1.010

摘要

本文旨在描述照顧一位服用巴拉刈自殺病人的急診護理經驗。照護期間為2012年3月18日至3月19日，護理過程中筆者運用Gordon十一項健康功能型態為評估架構，並藉由觀察、會談、身體評估、病歷查閱等方式收集資料，發現個案有低效性呼吸型態、急性疼痛與死亡焦慮共三個健康問題。照護過程透過急診醫護團隊合作，優先進行毒化物除污，氣管內插管、給予藥物與輸液以穩定病人的生命徵象，後續進行胃灌洗、灌活性碳等降低毒物傷害的措施，予口腔護理及止痛方法緩解口腔潰瘍所引起的疼痛，最後藉由心理支持、放鬆技巧、照會社工、家屬陪伴與靈性護理等方法處理個案的死亡焦慮，並轉入加護病房接受後續照護。個案最後終因多重器官衰竭往生，但也在身心安適下讓家屬與個案生死兩無憾。期望藉此個案的照護經驗，分享急診護理人員在毒化物中毒與自殺個案照護的角色職責，建議急診單位透過急重症全人照護、特殊個案照護與跨領域團隊照護的經驗分享與模擬演練，提升急診護理人員的專業照護能力。

關鍵字

巴拉刈中毒 ； 自殺 ； 低效性呼吸型態 ； 口腔潰瘍疼痛 ； 死亡焦慮

並列摘要

This case report describes the emergency nursing experience of caring for a patient who attempted suicide by paraquat poisoning. During the nursing period from March 18 to March 19 in 2012, we performed an assessment using Gordon's Functional Health Patterns and collected data through observation, conversation, physical assessment, and chart review. Three health problems were identified as follows: ineffective breathing pattern, acute pain, and death anxiety. During the nursing process, through emergency medical team cooperation, the patient was first treated with decontamination of toxic chemical substances, endotracheal intubation, and intravenous medications and fluids to stabilize vital signs; then the patient was treated with gastric lavage and activated charcoal to reduce the absorption of poisonous substances and given oral care and pain control to alleviate pain from oral ulcers; and finally the patient was given psychological support, relaxation techniques, social work consultation, family support, and spiritual care to cope with death anxiety and transferred to an ICU for further treatment. The patient eventually died of multiple organ failure. However, during the process the patient and family members achieved maximum physical and mental well-being and had no regret. This nursing experience could serve as a reference for emergency nurses in caring for patients with suicide attempt by poisoning. We suggest that the emergency unit should conduct experience sharing and simulation practice sessions regarding acute and critical holistic health care, special care, and inter-professional practice, thereby improving emergency nurses' professional nursing competencies.

並列關鍵字

Paraquat intoxication ； Suicide ； Ineffective breathing pattern ； Oral ulcers pain ； Death anxiety

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