初次罹患心肌梗塞併發心因性休克患者之護理經驗

Nursing Experience of a Patient with First Acute Myocardial Infarction Combined with Cardiogenic Sock

吳淑芬(Shu-Fen Wu) ； 李來涼(Lai-Ling Lee) ； 詹慧珠(Hui-Chu Chan)

《新臺北護理期刊》 13卷2期 (2011/11) Pp. 125-134

https://doi.org/10.6540/NTJN.2011.2.013

摘要

本文描述一位37歲初次罹患急性心肌梗塞併發心因性休克患者之照護經驗，筆者於2008年12月27日至2009年1月10日照護期間透過觀察、身體評估、會談及運用羅氏適應模式理論來評估病患，進而資料分析歸納，確立病患的護理問題為：心肺組織灌流失效、對檢查與治療的不確定感、對預後與自我照顧的不確定感。筆者運用敏銳觀察力及善用評估量表，提供完善之護理措施，如嚴密監測及穩定生命徵象，提供生理照護，預防心律不整、心臟衰竭等合併症發生；建立信任關係，隨時注意及關懷病情變化；適時提供心臟復健護理指導等，幫助個案調整生活型態、控制危險因子、增進生理及心理健康，進而增進自我照顧能力，維持生活品質。筆者期望藉此照護經驗，提供護理人員照護類似病患的參考。

關鍵字

急性心肌梗塞 ； 羅氏適應模式 ； 不確定感

並列摘要

BACKGROUND: Quality nursing care is paramount for patients hospitalized with acute myocardial infarction (AMI). With the aging population and an increase in the prevalence of cardiac disease, it is important to determine appropriate nursing protocols/parameters to meet the needs of cardiac patients while they are in the hospital. The purpose of this study was to identify problems associated with current AMI protocol employed and suggest alternative solutions to better care patients following hospitalization for a cardiac event.METHODS AND RESULTS: A 37-year old male who suffered from the first attack of AMI with cardiogenic shock as complication was admitted to the hospital from December 27, 2008 to January 10, 2009. During this period, we assessed the patient through observation, physical examination and communication, and the use of Roy's adaptation model. Three nursing problems were identified as follows: 1. inadequate tissue perfusion of cardiopulmonary system during in-hospitalization, 2. uncertainty about examination/treatment, and 3. uncertainty about disease prognosis/self-care for patients after discharge.CONCLUSIONS: Implementation of appropriate nursing protocols is crucial to improving quality of care and outcome after AMI. This article discusses some available means to better measure and optimize the quality of care for patients with AMI. Alternative nursing protocol while the patient is hospitalized can include the following: close observation and monitoring of vital signs, good use of the Scale for evaluation, and prevention of undesired side-effects such as arrhythmia and heart failure during the time in an intensive care unit. Guidelines, such as establishing good rapport amongst patient and healthcare workers, close monitoring of disease progression, providing cardiac rehabilitation, helping adaptation of life style, and controlling risk factors during post-hospitalization can improve AMI patients' physical and mental health as well as quality of life.

並列關鍵字

acute myocardial infarction ； Roy's adaptation model ； uncertainty