一位到院前心跳停止病人復甦後之加護護理經驗

Nursing Care Experiences of the Patient with Out-of-Hospital Cardiac Arrest in Intensive Care Unit at the Post-Resuscitation Phase

戴筠臻(Yun-Jhen Tai) ； 王筱珮(Shiao-Pei Wang)

《臺大護理雜誌》 14卷1期 (2018/01) Pp. 67-78

https://doi.org/10.6740/NTUHJN.201801_14(1).0008

摘要

本文個案為因心室纖維顫動而心跳停止之重症病人，經急救恢復自發性循環後，於本加護病房接受急救復甦後低溫治療之處置及照護過程。於2015年9月17日至10月6日護理期間，藉由直接照護、觀察、筆談會談及查閱病歷等方式蒐集資料，針對生理、心理、社會及靈性層面進行整體性評估，確立個案健康問題為腦組織灌流失效、心輸出量減少與無望感。護理過程的目標為避免因急救及腦部再灌流造成神經損傷，除監測意識狀態、調控並記錄溫度外，需預防併發症的發生；穩定血液動力學變化及提供適當的處置使心輸出量增加；個案於恢復意識後，卻因無法控制自己身體，生活功能皆需要協助，不確定心律不整是否會復發，且因近幾年身體狀況欠佳進出醫院頻率高，表現無望感。護理期間除運用主動關懷、傾聽、陪伴外，鼓勵表達內心害怕及對死亡看法，並對個案狀況安排每日活動目標與計畫，增進其自我照顧能力，以及降低面對擔憂疾病所致的失能。引導家屬和個案討論未來危急狀況時急救與否的看法，以期達到家屬能執行符合個案願望之決定。

關鍵字

到院前心跳停止 ； 無望感 ； 低溫治療 ； 不施行心肺復甦術意願

並列摘要

This article discussed the nursing care experiences of the patient with out-of-hospital cardiac arrest due to ventricular fibrillation. After cardiopulmonary-cerebral resuscitation, his spontaneous circulation was recovered, and the patient then transferred to intensive care unit to receive the therapeutic hypothermia. Data was collected through direct care provision, observation, written interview with the patient, and medical chart review from 17 September to 16 October 2015. After the body-mind-spirit holistic nursing assessments, the patient’s health problems were ineffective brain perfusion, decreased cardiac output, and hopelessness. The nursing care aimed to avoid the neurological damage from brain reperfusion after resuscitation, in addition to closely monitoring consciousness levels, regulating and recording body temperature to prevent the occurrence of complications, stabilizing hemodynamic status, and increasing cardiac output. After patient recovering consciousness, the patient's hopelessness was manifested in his inability to control his body, reliance on others for his daily functions and worry about the recurrence of arrhythmia. His health status was poor, and he was repeatedly hospitalized in recent years. Nurses not only provided active and caring attitudes, and listened attentively but also encouraged the patient to express his feelings of fear and thoughts about death. Meanwhile, we arranged daily life activities to enhance his self-care ability and reduce his worry about disability due to disease. We also encouraged family members to discuss with the patient about whether or not he wanted to receive cardiopulmonary resuscitation in the hope that family members could make a decision which met the patient's expectation.

並列關鍵字

out-of-hospital cardiac arrest ； hopeless ； therapeutic hypothermia ； do-not-resuscitate