一位到院前心跳停止個案之加護照護經驗

The Intensive Care Experience in an Out-Of-Hospital Cardiac Arrest Patient

10.6692/KJN.202005/SP_37.0013

陳家寧(Chia-Ning Chen)；蔡曉雯(Hsiao-Wen Tsai)

低溫療法 ； 多重感覺刺激 ； 心跳停止 ； 焦慮 ； therapeutic hypothermia ； multi-sensory stimulation ； Cardiac Arrest ； anxiety

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

148 - 159

繁體中文

本文描述一位患有心臟病史到院前心跳停止之個案，經急救後轉加護病房之照護經驗，因意識昏迷無法自主呼吸，可能面臨生活失能及家庭崩垮，於2016年3月25日至4月8日照護期間，採用Gordon十一項功能性健康型態進行整體性評估，確立主要健康問題為感覺與知覺改變、呼吸器戒斷反應功能失常與主要照顧者焦慮。即時介入低溫治療與多重感覺刺激療法，使意識狀態由E1VEM1復甦至E4V2M6，並以跨團隊照護模式及依個別性擬訂呼吸訓練計畫，最終順利脫離呼吸器；運用貝克焦慮量表，發現家屬焦慮問題，採主動關懷及非語言溝通，予正向支持並共同參與照護活動，成功緩解焦慮，協助個案及家屬度過危機，返家回歸社區，期望藉此分享成功實證照護經驗給護理人員作為參考。

This article describes nursing experience caring for an out-of-hospital cardiac arrest patient. The patient was administered emergency first-aid, and then transferred to the intensive care unit. Due to loss of consciousness and the inability to respirate on his own, the patient might have faced lifetime disabilities and the potential for family difficulties. During the intensive care period, from March 25, 2016 to April 8, 2016, the Gordon's Eleven Item Functional Health Indicators were used to holistically assess the major health problems: sensory and consciousness changes, ventilator withdrawal difficulties, and the anxiety of the primary caregiver. Immediate interventional therapeutic hypothermia and multi-sensory stimulation therapy was administered. The patient's state of consciousness improved from E1VEM1 to E4V2M6. Also, a respiratory training program was formulated by a cross-disciplinary team and individualized to the patient. The ventilator was eventually removed from the patient smoothly. Using the Beck Anxiety Inventory, the patient's family members were found to be extremely anxious. But through active caring and non-verbal communication, staff gave positive support and allowed the family to participate in care activities, successfully alleviating their anxiety and helping the patient and family members survive their crisis, being then able to return home. The authors expect to share this successful empirical experience as a reference for nurses.