- 期刊
學齡期心衰竭病童使用心室輔助器等待換心之加護經驗
Nursing Experience of Caring for a School-Aged Child with Heart Failure Supported with a Ventricular Assistance Device Awaiting Heart Transplantation
摘要
本文描述先天性心臟病病童心衰竭等待換心之護理經驗。個案因嚴重心衰竭而裝置心室輔助器以穩定心輸出量及維持其他器官血液供應，爭取等候心臟移植的時間。在陌生的加護環境接受各種侵入性治療、身體活動受限及探病時間限制，且需倚靠外來的管路及體外維生儀器來維持生命的不確定感皆對學齡期的個案內心產生巨大衝擊。筆者照護期間自2019年2月25日至5月23日，透過觀察及會談、身體評估、直接照護並運用整體性評估，經整理分析後確立個案主要健康問題有：（一）心輸出量不足；（二）急性疼痛；（三）無力感。護理過程中與醫療團隊合作，藉由調整用藥，減輕疼痛感；提供個案和案母疾病知識及飲食指導，建立良好的護病關係，鼓勵個案闡述負面感受。因兒童進行換心個案數少，期待分享此護理經驗使加護單位了解兒童等待換心期間所面臨的挑戰並思考依其年齡層發展特性提供適切的照護措施。
並列摘要
This paper describes the nursing experience of caring for a child with severe congenital heart disease who underwent the Fontan procedure. The patient's symptoms were exacerbated due to the disease progression, resulting in the requirement of a left ventricular assistance device for stabilizing cardiac output and managing circulation as a bridge to heart transplantation. The patient underwent treatment in a pediatric cardiac intensive care unit from February 25, 2019, to May 23, 2019. Data were collected through observations, interviews and physical assessments. Additionally, a holistic nursing assessment was performed by considering five major aspects. The main nursing problems identified were insufficient cardiac output, pain and a sense of powerlessness. During the nursing care process, a supportive environment was provided to encourage the patient and her family to express their anxious feelings. We provided information regarding disease care and dietary guidance to the patient to reduce the level of uncertainty, and the patient successfully survived the bridge to heart transplantation. The nursing care experience described in this study could help other professionals efficiently manage similar patients. Because of limited heart donations among Taiwanese children, the use of mechanical assistance devices for providing a bridge to heart transplantation has become a standard method to maintain their vulnerable lives. By sharing this nursing experience, the authors aim to highlight the most challenging aspects of caring for children waiting to receive heart transplantation and suggest appropriate interventions for children.