一位急性心肌梗塞併發心因性休克病人之護理經驗

Nursing Experience of An Acute Myocardial Infarction Complicated by Cardiogenic Shock Patients

林瑞英(Jui-Ying Lin)

《馬偕護理雜誌》 7卷1期 (2013/01) Pp. 94-102

https://doi.org/10.29415/JMKN.201301_7(1).0010

摘要

本文探討一位男性病人因急性心肌梗塞，施行冠狀動脈氣球擴張術併發心因性休克的護理過程，護理期間為2009年10月30日至2009年11月04日，筆者運用觀察、會談及依羅氏適應模式進行整體性評估，確立個案主要護理問題有心輸出量降低、焦慮、性功能障礙等；因病人有呼吸急促、血壓降低、頸靜脈怒張、尿量減少、皮膚溼冷、心輸出量降低併心因性休克，引發死亡威脅產生焦慮，當病情趨於穩定後，又極度擔心出院後性生活會引起疾病復發或猝死之可能性，運用關懷、支持、傾聽、與陪伴，以增加個案對治療的信心，進而減少死亡焦慮及給予安全性生活的觀念與重要性，使個案獲得身、心、靈之康復順利轉出加護病房，期望藉此護理經驗，提供臨床護理同仁照顧此類病人之參考。

關鍵字

急性心肌梗塞 ； 心因性休克 ； 護理經驗

並列摘要

This article is about nursing process for a male patient's acute myocardial infarction, and concurrency cardiogenic shock during the percutaneous transluminal coronary angioplasty (PTCA) procedure. The nursing period is from 30 October, 2009 to 04 November 2009. The author observed, and applied Roy's adaptation theory for holistic assessment. The case is noted that the major nursing issue included addressing cardiac output reduction, anxiety and sexual dysfunction. Results found that the patient had the symptoms of shortness of breath, low blood pressure, hypotension, hypo perfusion, decreased urine output, cool extremities, excessive sweating, reduction of blood flow, and cardiogenic shock. Even when the illness is stabilized, the anxiety, caused by threat of death, and intense worry about their sex life after discharge, could cause the patient to relapse. The practical application of care and support, listening, and accompanying, increases patient's confidence on the treatment. Thereby the patient reduced the anxiety about dying and was given the correct idea of security to conduct a healthy sex life. The physical, mental and spiritual rehabilitation will help the patient smoothly leave the intensive care ward. This article provides clinical nursing colleagues the information needed to take care of these patients.

並列關鍵字

Acute myocardial infarctions ； cardiogenic shock ； care experience