照顧一位裝置心臟調節器患者之護理經驗

Nursing Experience of Caring a Patient with an Implanted Pacemaker

吳美碧(Mei-Bi Wu) ； 宋怡憓(Yi-Hui Sung) ； 李彩緣(Chai-Yuan Lee)

《若瑟醫護雜誌》 7卷1期 (2013/08) Pp. 85-94

摘要

本文旨在探討一位87歲個案因退化性心臟疾病導致心搏過緩，須裝置永久性心臟調節器（Permanent Pacemaker; PPM）之護理經驗。護理期間自2010年4月25日至4月28日，藉由觀察、會談、身體評估及查閱病歷等方式收集相關資料，並運用Gordon 十一項健康功能型態加以分析歸納，確立個案有「心輸出量減少／心臟瓣膜及傳導功能退化」、「高危險性感染／裝置PPM傷口」、「焦慮／害怕死亡及缺乏裝置PPM相關知識」等護理問題。照護過程給予氧氣使用減輕胸悶不適，採舒適臥位減少心臟工作負荷；教導以正確無菌技術執行換藥，預防傷口感染；建立良好護病關係，引導個案說出焦慮的原因，並向個案及家屬解釋裝置PPM手術過程及合併症，以減輕焦慮，並藉由此護理經驗之分享，作為臨床護理同仁照護裝置PPM之老年病患時的參考。

關鍵字

心臟調節器 ； 護理經驗

並列摘要

The aim of this article is to report the nursing experience about taking care of an 87 years old patient who required permanent pacemaker (PPM) implantation for bradycardia caused by degenerative heart disease. The nursing period was 25th April to 28th April 2010. Data collection approaches consisted of observation, conversation, physical assessment and chart review, followed by analysis based on the Gordon’s 11 Functional Health Patterns. The identified nursing-related problems were including reduced cardiac output/degenerative cardiac valves and impaired signal transduction, increased risk of infection of PPM-associated wound, anxiety/fear of death and lack of PPM-associated knowledge. During the nursing period, the patient was provided with oxygen supplement to alleviate the discomfort of chest distress and maintain a comfortable supine position to reduce the cardiac workload. To prevent wound infection, the patient was trained to practice aseptic techniques for dressing changes. Good nurse-patient relationship was developed to help patient elucidate the causes of anxiety. Meanwhile, comprehensive explanation of PPM implantation surgery and complications were introduced to the patient and families, which subsequently reduced the level of anxiety. By sharing this experience of nursing as a reference, the clinical nursing staffs may be benefited from it for caring the elderly receiving PPM implantation.

並列關鍵字

Pacemaker ； Nursing experience