照顧一位腦動脈瘤破裂出血患者術後的加護病房護理經驗

Post Surgical Nursing Experiences of Caring for a Patient with Bleeding Due to Cerebral Aneurysmal Rupture in ICU

高僖黛(Hsi-Tai Kao) ； 李愛誠(Ai-Cheng Li)

《中山醫學雜誌》 22卷2期 (2011/06) Pp. 205-214

https://doi.org/10.30096/CSMJ.201106.0007

摘要

本文係探討一位腦動脈瘤破裂造成蜘蛛膜下腔出血致意識不清的個案術後加護病房照護之護理經驗。護理期間自98年1月28日至98年2月12日，以羅氏適應模式理論為架構，藉由直接照護、觀察及與家屬會談收集資料並進行整體性之護理評估。術後置氣管內管呼吸器使用，因咳嗽能力差、痰液蓄積致肺炎；動脈瘤破裂術後併有顱內壓上升問題；家屬因對疾病不了解而產生失控、緊張、焦慮等情緒，確立個案護理問題有：呼吸道清除功能失效、顱內調適能力降低、照顧者角色緊張。透過1.積極胸腔照護維持適當氧合，使個案能有效性咳嗽，以漸進方式脫離呼吸器；2.儘量減少Valsalva活動，提供安靜的環境並執行降低顱內壓相關護理措施；3.定時舉辦家屬座談會，讓家屬對個案的治療步驟及病情進展能隨時掌握了解；4.鼓勵及引導家屬表達內心的情緒，給予正向支持，增進自信心，讓家屬能以積極正向的態度面對未來生活。此次照護不僅使個案護理問題得以解決外，同時也加強家庭支持系統，協助家屬獲得心理層面的照護，期望經由此經驗分享，提供護理同仁日後面對腦動脈瘤破裂出血患者照護上之參考。

關鍵字

腦動脈瘤 ； 蜘蛛膜下腔出血 ； 護理經驗 ； 加護病房

並列摘要

This paper describes nursing experiences of caring for an unconscious patient with subarachnoid hemorrhage caused by cerebral aneurysmal rupture in an intensive care unit. The nursing period was from January 28 to February 12 in 2009. Using the Roy Adaptation Model as the framework, data were collected from direct attendance, observation, and interview with the patient's family members. A comprehensive nursing evaluation was also conducted. After operation, the patient was put on inner trachea respirator. He had poor cough reflex and an accumulation of sputamentum leading to pneumonia. After operation on the cerebral aneurysmal rupture, there was an increase in encephalic pressure. Due to their unfamiliarity with the illness, the patient's family members experienced feeling of being out-of-control, tension and anxiety. Based on the above, the nursing problems of the patient were determined as follows: failure to clear respiratory tract, decline of the encephalic adaptation capacity, and caretaker anxiety. Active thoracic cavity care was conducted to maintain adequate oxygenation, so that the patient could cough effectively and gradually be weaned from the respirator. Valsava activities were reduced as much as practicable, quiet environment was provided, and relevant nursing measures were taken to reduce encephalic pressure. Periodic interviews were held with the family members to acquaint them with treatment steps and progress of the health condition of the patient. They were also encouraged to express their emotions. Positive support was given to improve their confidence and enable them to face future life positively and actively. Taking these steps, we were able to solve the nursing problems of the patient and provide emotional support to the family members. This report can serve as a reference for nursing staff members when attending to patients with bleeding caused by cerebral aneurysmal rupture in the future.

並列關鍵字

cerebral aneurismal rupture ； subarachnoid hemorrhage ； nursing experiences ； Intensive Care Unit