照顧一位二度二型房室傳導阻斷病人之重症照護經驗

Caring Experience of a Patient with Second-Degree Type II Atrioventricular Conduction Block in Intensive Care Unit

10.29494/LN.202203_23(1).0007

李儀玲(Yi-Ling Li)；周云鵑(Yun-Juan Chou)；葉惠玲(Hui-Ling Yeh)

二度二型房室傳導阻斷 ； 心包填塞 ； 永久性心臟節律器 ； second-degree type II atrioventricular conduction block ； cardiac tamponade ； Permanent Pacemaker

領導護理

23卷1期（2022 / 03 / 01）

76 - 90

繁體中文

本文探討一位老年二度二型房室傳導阻斷病人接受暫時性心臟節律器後併發心包填塞合併症，而決定植入永久性心臟節律器之重症護理經驗。於2019年01月17日至01月24日，運用Gordon十一項功能性健康評估，透過直接護理、觀察、傾聽及會談收集資料，確立病人有心臟組織灌流失效、急性疼痛、焦慮三個主要健康問題。於第一時間發現心包填塞合併症給予緊急心包膜穿刺術引流694ml血水，監測心音及心電圖以維持心臟足夠灌流，照護期間因管路及傷口疼痛，給予藥物及非藥物方法如播放喜歡的日本音樂以及局部肢體按摩，減輕其疼痛，增加舒適感。此外於加護病房期間調降儀器聲響，並運用醫病共享決策提供心臟節律器置入之影片，提升病人對於治療認知進而降低焦慮。希望能藉此護理過程之經驗分享，作為護理同仁對日後照顧此類病人提供適切護理。

This article discusses the intensive care experience of an elderly patient with second-degree type II atrioventricular conduction blockade who received a Temporary Pacemaker but complicated with cardiac tamponade and hence decided to implant a Permanent Pacemaker. From January 17 to 24 in 2019, applied Gordon's eleven functional health assessments to collect data through direct care, observation, listening, and interviews; it is established that the patient has encountered three main health issues: cardiac failure tissue perfusion, acute pain, and anxiety. When the complications of cardiac tamponade was discovered at the first instance, emergency pericardiocentesis was given to drain 694 ml of blood, the heart sounds and electrocardiography were monitored to maintain adequate cardiac perfusion. During the nursing period, due to the pain caused by the pipeline and the wound, applied both drugs and non-drug methods such as playing favorite Japanese music and local body massage to relieve pain and improve comfort level. In addition, while staying in the intensive care unit, the volume of the instrument was lowered, and the medical and patient sharing decision was applied to provide a video of the cardiac pacemaker implantation for improving the patient's awareness of treatment and lessen anxiety. By sharing this experience, the author hopes it can serve as a reference for clinic staff to provide appropriate care when caring for similar patient in the future.

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