照顧一位感染海洋弧菌併發敗血性休克病人之急診護理經驗

Emergency Nursing Care for a Marine Vibrio-Infected Patient Complicated with Septic Shock

陳楷勳(Kai-Hsun Chen) ； 凃懿如(I-Ju Tu) ； 林家琪(Chia-Chi Lin) ； 顧景玉(Ching-Yu Ku)

《榮總護理》 36卷1期 (2019/03) Pp. 96-102

https://doi.org/10.6142/VGHN.201903_36(1).0010

摘要

本文探討一位中年男性到菲律賓潛水時被不明海洋生物咬傷右手臂，感染海洋弧菌後併發敗血性休克的急診護理經驗，護理期間2017年10月20至22日，利用Gordon十一項健康功能型態作為評估架構，藉由身體評估、觀察、會談及病歷調閱等方式，確立病人主要健康問題有組織灌流改變、疼痛、焦慮。筆者運用耐心、同理心、傾聽與關懷，了解病人的身心靈需求，偕同急診醫護團隊共同參與照護活動，正確且仔細的處置及提供個別性的護理照顧，例如：提供氧氣、更換合適的抗生素及使用升壓劑治療、尊重與鼓勵其利用禱告方式緩解焦慮，終使病人休克症狀及焦慮情形改善，逐漸恢復健康。有鑒於臺灣為亞熱帶海島國家，海上活動及食用海鮮是臺灣民眾輕易可接觸的，且感染海洋弧菌致死率極高，因此引發筆者想深入探討及分享此次照護的動機，期盼藉此次的護理經驗與同仁分享，並作為日後臨床照顧之參考。

關鍵字

海洋弧菌 ； 敗血性休克 ； 傷口照護 ； 焦慮 ； 急診護理

並列摘要

This article describes the emergency nursing care of a middle-aged man who travelled to the Philippines and was accidentally bitten on the right arm by unidentified marine organisms while diving. He then developed marine vibrio infection complicated with septic shock. The nursing period lasted from October 20 to October 22 2017, with Gordon's 11 Functional Health Patterns applied to the evaluation framework using physical assessment, observation, medical chart reviews, and written communications. The main symptoms of the patient were tissue perfusion alterations, pain, and anxiety. The author used patience, empathy, listening, and concern to establish the patient's spiritual and mental needs and help him participate in the care activities with the emergency care team properly and carefully. We provide concrete and detailed application as well as individualized nursing care, such as oxygenation, appropriate antibiotics, vessel contracture agent therapy, respect and encouragement of religious behaviors, and prayer to reduce anxiety. Allowing the patient to participate in care decision-making increases self-confidence, and the patient's symptoms eventually improved whose health were gradually getting better. Taiwan is a subtropical island country. Marine activities and seafood consumption are common among Taiwanese people; therefore, the mortality rates for Vibrio anguillarum infection are extremely high. As a result, discussion and sharing of the motivation of nursing experience with colleagues and take it as a reference for clinical care in the future.

並列關鍵字

marine vibrio ； septic shock ； wound care ； anxiety ； emergency care

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