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照顧一位心肌炎合併使用體外心肺循環機病患之護理經驗
The Experience of Caring a Patient with Myocarditis by Extracorporeal Membrane Oxygenation
摘要
本文主要探討一位心肌炎病患因心臟衰竭使用體外心肺循環機（Extracorporeal Membrane Oxygenation, ECMO）照護經驗，護理期間自2010年10月22日至2010年11月5日，運用直接護理、溝通、觀察、病歷查閱進行資料收集，以羅氏適應護理模式評估及分析，發現主要護理問題有心輸出量減少、危險性傷害、腎組織灌流改變及焦慮等；針對心臟衰竭使用ECMO以增加心輸出量、穩定生命徵象；對於傷口大量出血，密切監測出血徵象；為維持腎臟血流，及改善急性腎衰竭症狀，使用連續性靜脈到靜脈血液透析，進而恢復腎臟功能；個案於加護病房期間因疾病急遽變化，感到生命受威脅，筆者以關懷態度的傾聽心理感受，建立良好護病關係後，鼓勵表達心中疑問，協助心理調適，運用文字書寫、文字卡、圖案說明，減輕個案對疾病產生的焦慮。病患於生、心理症狀改善後，終能順利移除體外心肺循環機，成功的存活，並康復出院。
並列摘要
This article describes a nursing experience of a patient with myocarditis who suffered from heart failure and he received Extracorporeal Membrane Oxygenation from October 22, 2010 to November 5, 2010. The data of the study was collected by the directly nursing care, observation, interview, conversational by writing, the medical records and follow-up interviews by authors. Roy's adaptation model of care assessment was used and four nursing problems including decreased cardiac output, high risk of harm, renal hypoperfusion, and anxiety were established. During the nursing period, the arrangement of ECMO increasing cardiac output and stabling vital signs; closely monitored the bleeding signs of the severe bleeding wound; used the continuous vein to vein hemodialysis for renal replacement therapy, improved the symptoms of acute renal failure, and then restore the kidney function. Due to rapid progression of the disease, the patient had the feeling that life is threatened in the ICU. The author established a good nurse-to-patient relationship to encourage the expression of doubt and to assist psychological adjustment, reducing the anxiety of the disease. After the improvement of the physiological and psychological symptoms, the cardiopulmonary bypass machine was removed smoothly. Finally, the patient survived and was discharged.
延伸閱讀
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