照護一位流感併發急性心肌炎病人之加護經驗

Nursing Experiences of Intensive Care for an Influenza Patient with Acute Myocarditis

10.29494/LN.202203_23(1).0005

李祐寧(Yu-Ning Lee)；林佩昭(Pei-Chao Lin)；黃麗娟(Li-Chun Huang)

流感 ； 體外膜氧合 ； 主動脈氣球幫浦 ； 連續性腎臟替代療法 ； influenza ； extracorporeal membrane oxygenation (ECMO) ； intra-aortic balloon pump (IABP) ； continuous renal replacement therapy (CRRT)

領導護理

23卷1期（2022 / 03 / 01）

49 - 62

繁體中文

本文描述一位因流感併發急性心肌炎的加護病房病人之護理經驗。護理期間自2019年2月28日至3月14日，運用Gordon十一項健康功能型態評估工具，透過觀察、會談及身體評估等方式確定健康問題有：心輸出量減少、高危險性損傷、焦慮。個案因B型流感引發急性心衰竭導致心輸出量減少，進而使用體外膜氧合、主動脈氣球幫浦維持心臟功能。另外，因抗凝劑使用及放置多重管路，曾有出血情形，故護理期間持續監測出血徵象，提供預防感染措施。護理期間以平穩語氣與病人及家屬溝通，與醫師共同向家屬說明病情及治療方向以緩解焦慮問題。於急性期結束後，給予個案飲食指引及減重控制方法。出院後，更持續追蹤術後傷口情形，衛教3個月內不能劇烈運動等，以達完整性照護。

This article describes the intensive care experience of myocarditis patient with influenza. During the nursing period from February 28 to March 14, 2019, the patient was observed, interviewed, and physically assessed by applying Gordon 11 Function Health Patterns. Consequently, the patient's health problems ascertained include: declined cardiac output, high risk of injury and anxiety. In this case, acute heart failure generated by influenza B prompts reduction of cardiac output. As a resolution, in order to maintain the heart functioning, extracorporeal membrane oxygenation, intra-aortic balloon pump was used to maintain cardiac function. In addition, due to the usage of anticoagulants and the placement of multiple lines, there had been circumstances of bleeding. Hence during the nursing period, continuation of monitor bleeding symptom and provide preventive measures was applied. Communicate with the patient and family members in a steady tone during nursing period, and explain the condition and treatment direction to the family with the doctor to alleviate anxiety. At the end of acute phase, provide the case dietary guidelines and weight loss control methods. After being discharged from the hospital, staff will continue tracking the postoperative wounds. The health education includes no aggressive exercises within 3 months and so on, to achieve complete caring process.

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