急性心肌梗塞併發惡性心律不整之急診護理經驗

Emergency Nursing Care of a Patient with Acute Myocardial Infarction and Malignant Arrhythmias

劉念怡(Nuen-Yi Liu) ； 劉珊玟(Shan-Wen Liu) ； 林敏玲(Min-Ling Lin)

《馬偕護理雜誌》 4卷1期 (2010/01) Pp. 87-95

https://doi.org/10.29415/JMKN.201001_4(1).0009

摘要

本文描述護理人員照護一位六十八歲男性病人，出現胸痛、盜汗和喘等症狀，而至急診求治，診斷為急性心肌梗塞，期間病人發生惡性心律不整而經心肺復甦術救治，提供其急症照護之護理過程。護理照護期間為2007年7月28日上午7:15至9:11，依Gordon十一項功能性健康評估，進行整體性評估並確立護理問題為疼痛、心肺組織灌流改變及焦慮。護理過程中，從處理病人之胸痛與惡性心律不整，到面對病人及家屬對疾病的疑慮、擔心及死亡的威脅等，運用關懷、傾聽等技巧，透過尊重、溝通與醫療團隊的合作，提供身、心、靈及社會整體照護。終成功的遏止病人惡性心律不整之復發並接受冠狀動脈成形術之血流再灌注治療，且獲得家屬的瞭解及信任。期盼藉此急診護理經驗，進而協助臨床護理人員對照顧此類病人提供整體性、高效率及高品質之急救護理。

關鍵字

急性心肌梗塞 ； 急診照護 ； 心律不整

並列摘要

A 68-year-old man presented to the Emergency Room with chest pain, sweating, and dyspnea and was diagnosed with acute myocardial infarction. The author cared for the patient for 2 hours, during which the patient had malignant cardiac arrhythmias and cardiac arrest, necessitating cardiopulmonary resuscitation. Patient evaluation based on Gordon's 11 Functional Health Status Assessment confirmed the following nursing diagnoses: pain, altered myocardial tissue perfusion, and anxiety. Nursing management included dealing with the patient's chest pain and malignant dysrhythmias, as well as helping him and his family cope with their misgivings and fears, particularly the threat of death. This required caring skills, listening, respect, and clear communication, helping the medical team provide wholistic care for the physical, emotional, spiritual, and social needs of the patient and family members. The recurrent malignant arrhythmias were eventually controlled and the patient was able to undergo percutaneous transluminal coronary angioplasty. The emergency care provided before that procedure helped us obtain the family's understanding and trust. Emergency nursing care of such patients requires efficient, high-quality professional skills.

並列關鍵字

acute myocardial infarction ； emergency care ； dysrhythmias