一位反覆食道靜脈曲張出血首次插管病人之加護經驗

本文為照顧一位成年男性因食道靜脈曲張反覆出血首次插氣管內管，於加護病房歷經放置食道球及胃鏡治療處置之護理過程。護理期間為2018年5月28日至31日，藉由直接照護、會談、觀察及查閱病歷等方式收集資料，依生理、心理、社會及靈性四大層面加以歸納分析，確立個案健康問題包括現存性出血性傷害、感染、呼吸道清除功能失效、焦慮及照顧者角色緊張等。照護期間經由監測生命徵象、穩定血流動力學、教導預防再出血方法、控制及預防感染、主動關懷並說明過程及目的、傾聽、陪伴、視病房環境提供放置宗教靈性物品給予心理支持、營造舒適環境、協助主要照顧者找到支持系統等措施，有效減輕其焦慮，使個案能安心地接受治療度過危急時刻。建議重症單位之護理師除了專注於穩定病人各項生命指數，亦可仔細且耐心地觀察病人的肢體與表情，運用合適的評估量表，發現病人潛在的焦慮與緊張問題，儘早介入給予適當的護理處置，將可更有效改善病情與提高護理品質。

關鍵字

食道靜脈曲張出血；焦慮；主要照顧者角色緊張；插管

並列摘要

This paper describes the intensive nursing care experience of a male patient with liver cancer and recurrent esophageal variceal bleeding receiving first-time intubation, placement of esophageal ball and gastroscopy. The nursing period was from May 28 to May 31, 2018. Information was collected by direct care, interviews, observations, and medical records. A nursing assessment was conducted in accordance with four major aspects including physical, psychological, social, and spiritual aspects. The health problems found during hospitalization were as follows: hemorrhagic injury, infections, respiratory clearance failure, and anxiety of the caregiver. During the care period, the patient's vital signs were monitored, hemodynamics were stabilized, health educations were provided, including preventing rebleeding, controlling and preventing infections, proactively caring and explaining the condition of illness, listening, companionship, and placing religious spiritual items in the bedside, providing psychological support and a comfortable environment, and assisting the main caregiver to find a support system. All those nursing interventions were implemented to effectively lessen the patient's anxiety so that the patient could be safely treated during a critical period. With this nursing experience, we suggest that although critical care units are very busy stabilizing each patient's physical condition, if healthcare professionals can carefully and patiently observe each patient's body expressions and use appropriate assessment scales, their psychological problems can be identified to provide early intervention and improve the quality of care in critical care units.

並列關鍵字

esophageal variceal bleeding ； anxiety ； caregiver role strain ； intubation

國際替代計量

一位反覆食道靜脈曲張出血首次插管病人之加護經驗

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