- 期刊
照護一位急性心肌梗塞患者併發心因性休克使用ECMO的護理經驗
Nursing Care of a Patient Undergoing ECMO for Acute Myocardial Infarction and Cardiogenic Shock
摘要
本文描述一位急性心肌梗塞併發心因性休克患者，住進加護病房接受體外膜氧合(Extracorporeal Membrane Oxygenation, ECMO)維生系統治療的護理經驗。護理期間為96年1月17日至1月31日，透過身體評估、觀察、會談及實際照護等方式收集資料，運用Gordon十一項健康功能評估，確立個案有現存性出血、潛在皮膚完整性受損、心肺組織灌流改變、液體容積過量、潛在危險性感染、焦慮等健康問題。在護理過程中，筆者針對個案護理問題，提供個別的護理措施，如主動維持身體舒適體位、敏銳觀察維生系統功能、保持傷口清潔、預防傷口感染及管路、迴路感染問題，以及有計畫的增進個案的心、肺組織功能等，結果個案接受四天的ECMO治療後，病情漸趨穩定，移除體外維生系統，並在良好的狀況下出院，回歸到社區生活。筆者期望此次照護經驗，可提供重症單位護理人員照護行ECMO治療者之技能及經驗分享，並將其運用在加護病房其他患者接受ECMO治療者之護理業務上。
並列摘要
In this article, we report the nursing experience of caring for a patient undergoing ECMO (extracorporeal membrane oxygenation) treatment for acute myocardial infarction and cardiogenic shock. During the period that the case received nursing care (17(superscript th) Jan. to 31(superscript th) Jan. 2007), nurses interviewed and observed the patient. Using the Gordon 11-item Functional Health Pattern Assessment, the authors characterized the patient's clinical problems as having ”active bleeding,” ”ineffective tissue perfusion,” ”excess fluid volume,” ”risk for impaired skin integrity,” ”risk for infection,” and ”anxiety.” Nursing care focused on paying particular attention to the patient's body comfort, the maintenance of physiological functions, keeping patient's wound clean and free from infection, and helping the patient gradually enter a cardiopulmonary resuscitation program. Once the patient had passed the critical stage, his condition stabilized, he was weaned from ECMO and transferred to the cardiac-vascular ward for continued observation. This successful nursing experience provides information that might be of use when caring for patients undergoing ECMO treatment in a critical setting in the future.
延伸閱讀
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