協助經產婦面臨羊膜囊滑脫安胎失敗之護理經驗

An Experience of Caring a Multipara Woman with Protruding Amniotic Membrane Resulted in Tocolysis Failure

10.29494/LN.200612.0007

陳珮瀅

子宮頸閉鎖不全 ； 安胎 ； 失落 ； incompetent cervix ； tocolysis ； loss

領導護理

7卷2期（2006 / 12 / 01）

65 - 77

繁體中文

本篇報告描述一位經產婦懷孕22週，因疑似子宮頸閉鎖不全合併羊膜囊滑脫至陰道引發早產現象，必須住院安胎治療，個案歷經7天住院安胎過程，積極配合所有醫療，堅強承受安胎藥的副作用、身體活動受到限制之舒適改變。個案時時處於陷入安胎失敗之危機，每天承受著焦慮安胎成功與否、擔心提早分娩生下早產兒。最後在懷孕23週時因提早破水而無法再繼續安胎治療，必須面臨安胎失敗，接受提早分娩及擔心分娩後早產兒存活之身心調適的護理經驗。筆者於94年10月17日至10月26日護理期間，與個案建立良好的人際關係，經由觀察、會談、傾聽，應用羅式護理適應模式歸納整理出確立的護理問題包括：焦慮、舒適型態改變、便秘、失落。根據此四項護理問題，護理人員應用護理過程給予鼓勵與支持，協助個案渡過安胎及生產的過程，提供個別性及整體性照護，期望透過獨特的護理過程及措施，緩解個案安胎期間的焦慮感受及生理不適，並能堅強地面對安胎失敗及協助儘快恢復失落的情緒。

This case study was to describe a 22 weeks-gestational multipara woman who has been suspected incompetent cervix with amniotic protruding membrane induced the signs of premature labor. During sevenday hospital stay, the case well cooperated with medical interventions, endured the side effects of tocolytic agents and activity restriction resulted in comfort alteration. Moreover, she was anxious the possibility of tocolytic failure with a premature birth. Finally the tocolysis failed because of premature membrane rupture, a 23 week premature baby was delivered. Later on, this case got to be anxious the survival of the premature baby. The writer was as a primary nurse from October 17 to October 23, 2005. The data were collected by observation, intervention, face to face interview and empathic listening. Using Roy's adaptation model to analyze the data, major problems were identified included: anxiety, comfort alteration, constipation and loss. During nursing process, the writer gave the case encouragement and support to help her to cross the difficult time of tocolysis failure with pre-term delivery. Providing an individualized and specific nursing intervention to help this case release the anxiety and physical pain from the tocolysis and delivery, wishing her to face the tocolysis failure and to recovery from the path of loss soon.