高預期性焦慮的高血壓患者之護理經驗

Nursing Care for a Hypertensive Patient with High Anticipation Anxiety

吳婷慈(Ting-Tzu Wu)

《北市醫學雜誌》 5卷6期 (2008/12) Pp. 652-663

https://doi.org/10.6200/TCMJ.2008.5.6.09

摘要

本篇報告係描述一位高血壓之獨居老婦，家中雙親及三位兄弟皆是高血壓併發腦中風驟逝，因本身血壓高造成呼吸喘、胸悶及恐懼高血壓可能併發腦中風影響自我照顧能力，而引發生理不適與心理壓力之護理經驗。筆者於2006年3月6日至3月10日的護理期間，運用Orem自我照護理論為評估架構，經由直接照護，溝通、觀察及會談等方式完成相關資料收集。經評估分析後，結果發現個案有：（一）心肺組織灌流改變與高血壓引起心肌血液灌流減少有關；（二）健康尋求行為與對缺乏高血壓認知及自我照顧訊息有關；（三）恐懼感與面對高血壓可能併發腦中風有關。過程中評估個案血氧情形，協助舒適臥位，床頭搖高30-60度及使用氧氣2L/min以利呼吸，依血壓值變化調整血壓藥物和劑量，提供低脂、高鉀、高鈣護理指導；並利用高血壓自我評量表，教導個案血壓自我測量方法及自我照顧方法；及鼓勵個案表達內心想法，對高血壓自我照顧舉動予口語表示讚美。結果在護理措施介入，其血氧量由92%提高到97%以上，胸悶情形改善；個案學會每天正確測二次血壓，高血壓自我評量表由30分提高至80分；個案以正面態度面對高血壓併發症，使恐懼感降低，進而提昇個案生活品質。

關鍵字

高血壓 ； 心肺組織灌流改變 ； 健康尋求行為 ； 恐懼感

並列摘要

Here we describe nursing experiences while caring for an elderly hypertensive woman who was living alone; this patient was suffering from both a physiology disease and psychology stress. The latter was due to the fact that both her parents as well as her three brothers had died from hypertension due to cerebrovascular accident complications. The nursing took place from March 6, 2006 to March 10, 2006 and data was collected as part of the direct care, by communication with, observation of and interviews with the patient and using the Orem self attention theory. The results suggested that the patient’s problems consisted of three parts. Firstly, the hypertension caused perfusion changes within the heart and lungs and this was related to decrease blood perfusion into myocardium. Secondly, the patient's attention seeking health behavior was related to a lack of understanding of hypertension. Finally, the patient's phobia in relation to the hypertension was a complication of a stroke. A number of adjustments were made in order to help the patient. Firstly, the blood oxygen concentration of the patient was assessed as part of the treatment and it was decided to raise the head of the bed by between 30 to 60 degrees and provide oxygen at a rate of 2 liter per minute; this made the patient feel more comfortable and it was easier for her to breath. Secondly, the patient's hypertension medicine and its dosage were adjusted in accordance with changes in her blood pressure. Thirdly, nursing guidance to the patient was provided with respect to a low fat, high potassium and high calcium diet. Fourthly, a self-assessment questionnaire on hypertension was used to tutor the patient about measuring her blood pressure and take care of herself. Finally, the patient was encouraged to express her ideas about her heart disease and these efforts were praised by the nurse. After the implementation of these nursing interventions, it was found that the concentration of oxygen in the blood had increased from 92% to 97% and that the chest discomfort had ameliorated. At the end of the intervention, the patient had learned how to take her own blood pressure and did this correctly twice every day. Furthermore, using a hypertension self-assessment questionnaire scale, her score had improved from 30 points to 80 points. Overall, the patient now faced the complications introduced into her lifeby hypertension with a positive attitude, showed a reduction in her phobia and had an overall improved quality of life.

並列關鍵字

hypertension ； perfusion change in heart and lungs organization ； attention seeking health behavior ； phobia