一位癌末病人突發心肌梗塞面對死亡焦慮之加護經驗

Intensive Nursing Care Experience about a Patient with Terminal Cancer who Suffered from Sudden Myocardial Infarction and Death Anxiety

10.6386/CGN.202109_32(3).0009

施怡如(Yi-Ju Shih)；藍雅渝(Ya-Yu Lan)；林玉菁(Yu-Ching Lin)

癌症末期 ； 急性心肌梗塞 ； 死亡焦慮 ； terminal cancer ； acute myocardial infarction ； death anxiety

長庚護理

32卷3期（2021 / 09 / 01）

106 - 117

繁體中文

本文描述一位鼻咽癌末期病人於病房內化療時發生急性心肌梗塞造成心跳休止，診斷心因性休克轉至加護病房，因病情嚴重度高且經歷死亡，對於疾病發展衍生出死亡焦慮，2018/3/10～3/16照護期間以羅氏適應模式為護理架構，進行訪談、觀察及身體評估收集資料，分析歸納出個案有心輸出量減少、急性疼痛及死亡焦慮健康問題，筆者藉由引導個案表達對疾病心理壓力與感受、提供相關文獻讓個案適應疾病變化及增強信念，肯定自我存在價值，降低對疾病產生的無力感，並使用藥物與其他技巧控制來緩解疼痛，期望藉此照護經驗分享，提供護理人員於臨床上照護類似個案能及早協助面對疾病引發相關心理層面問題之照護參考。

This article described the experience of caring a patient with terminal nasopharyngeal cancer who experienced sudden death secondary to acute myocardial infarction when admitted for chemotherapy treatment. The patient was then transferred to the intensive care unit (ICU) for further care of cardiogenic shock. Death anxiety was precipitated because of his life-threatening condition and previous experience of death. The nursing care period was from March 10 to 16, 2016. A structured nursing care was performed following Roy's adaptation model. Information were collected from direct observation, physical assessment, and conversation. The main health problems included reduced cardiac output, acute pain, and death anxiety. The patient were instructed the following strategies: to openly express stress and feelings, to improve understanding of disease through readings, to adapt to heath conditions, and to enforce belief to reduce the sense of powerlessness. Medications and other skills for pain control were also provided. This report shares the experience of helping patients face the psychological aspects of a disease.

1. 邱姿容, T.J.,王玉女, Y. N.(2018)。一位急性心肌梗塞接受冠狀動脈繞道手術病患之加護護理經驗。長庚雜誌，29(1)，120-129。
   連結：
2. 趙可式, C. S.(2015)。安寧療護是普世價值且為護理的本。護理雜誌，62(2)，5-12。
   連結：
3. Costa, C.,Costa, Linch, G. F.,Souza, N. E.(2016).Nursing diagnosis based on signs and symptoms of patients with heart disease.International Journal of Nursing Knowledge,27(4),210-214.
4. Kotfis, K.,Zegan-Baranska, M.,Szydlowski, L.,Zukowski, M.,Ely, W.E.(2017).Methods of pain assessment in adult intensive care unit patients.Anesthesia Intensive Therapy,49(1),66-72.
5. National Center for Complementary and Alternative Medicine. (2016). Introduction. https://www.nccih.nih.gov/about/strategic-plans/introduction
6. Roes, A. M.,Martens, E. J.,Johan, D.(2010).Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: A meta-analysis.Journal of Bio behavioral Medicine,72(6),563-569.
7. Roy, S. C.,王樊雯（譯）(1991).羅氏護理適應模式.台北市:華杏.
8. Santos, V. B.,Atallah, A. N.,Lopes, C. T.,Lopes, Jde L.,Bottura Leite de Barros A. L.(2016).Defining characteristics and related factors of decreased cardiac tissue perfusion: Proposal of a new nursing diagnosis.International journal of nursing knowledge,27(3),175-180.
9. 行政院衛生福利部 (2017，06 月 19 日 )˙105年死因統計分析 ˙ 取自 https://dep.mohw.gov.tw/DOS/lp-3352-113.html。[Ministry of Health and Welfare (2017, June 19). 2016 Statistical analysis of death causes. Retrieved from https://dep.mohw. gov.tw/DOS/lp-3352-113.html]
10. 李淑惠, S. H.,吳之妘, C. Y.,李欣樺, H. H.(2012)。協助個案渡過喪偶哀傷過程之家庭護理。領導護理，13(2)，67-78。
11. 明金蓮, J. L.,洪曉佩, S. P.(2011)。急性疼痛評估與症狀護理•源遠護理。源遠護理，5(1)，11-15。
12. 高紀惠（譯）, J. H.,曾詩雯（譯）, S. W.,莊琬笙（譯）, W. S.(2012).NANDA International 護理診斷 :定義與分類.台北市=Taipei:華杏=Hoaxing.
13. 賴文源, W. Y.,顏兆雄, J. S.(2012)。急性心肌梗塞。當代醫學，39(3)，221-229。
14. 賴維淑, W. S.(2014)。哀傷撫慰之陪伴理論。安寧療護雜誌，19(1)，67-75。

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