初次急性心肌梗塞之急診護理經驗

Nursing Care for a Patient with First Acute Myocardial Infarction Attack in Emergency Room

李金媛(Chin-Yuan Li) ； 徐玉枝(Yu-Zhi Hsu) ； 蔡佳樺(Chia-Hwa Tsai)

《北市醫學雜誌》 5卷6_S期 (2008/12) Pp. 765-774

https://doi.org/10.6200/TCMJ.2008.5.6.21

摘要

本篇旨在描述照顧一位54歲初患心肌梗塞的個案，護理期間為2006年6月21日至2006年6月28日，運用Gordon十一項功能性健康型態評估項目為評估架構，經由直接照護、身體評估、觀察、會談方式收集相關資料。結果發現個案有：心肺組織灌流改變、急性疼痛、焦慮等護理問題。經由提供氧氣、給予血管擴張劑、利尿劑等藥物使用；提供Morphine止痛劑、採取舒適臥位、教導減輕疼痛等方法；鼓勵表達焦慮來源、提供心肌梗塞完整資訊、教導放鬆技巧等護理措施介入後，結果使個案的血氧濃度由85%提升到95%、肺水腫改善，疼痛評估量表由8分降至3分，自訴胸痛改善，同時在提供系統性衛教指導後，個案之焦慮程度得以減輕。

關鍵字

心肌梗塞 ； 心肺組織灌流改變 ； 急性疼痛 ； 焦慮

並列摘要

This report describes a male, who committed suicide by taking paraquat. Although this patient did eventually die as a result of paraquat poisoning and the subsequent idiopathic pulmonary fibrosis that followed, this case focuses on the treatment given on his admission to hospital. We used the 11 items of Gordon's Functional Health Pattern Model as an assessment framework and collected data through direct care, physical assessment, observation and interview. By this means we established that his labored breathing pattern was related to taking paraquat and had resulted in pulmonary edema and idiopathic pulmonary fibrosis, which then led to tachypnoea. The oral mucosa had also been burnt from taking paraquat. We, therefore, directly inserted an endotracheal tube into his trachea and used a respirator on the patient. We also provided Demerol 50mg and a 2% Xylocaine mouthwash. Next, we set up an intravenous infusion, and provided him with psychological support. In the meantime, we put the patient on a fast and referred social workers to the patient's wife to provide her with spiritual care and counseling.

並列關鍵字

paraquat intoxication ； idiopathic pulmonary fibrosis ； pulmonary edema