照護一位初次罹患急性心肌梗塞病患之加護經驗

An Intensive Care Nursing Experience of an Acute Myocardial Infarction Patient

張麗君(Li-Jun Jang)；胡眞珍(Jen-Jen Hu)

急性心肌梗塞 ； 主動脈內氣球幫浦 ； 加護經驗 ； acute myocardial infarction ； intra-aortic balloon pump ； nursing experience

志為護理-慈濟護理雜誌

17卷4期（2018 / 08 / 01）

127 - 136

繁體中文

本文描述一位65歲女性，初次罹患急性心肌梗塞併發心因性休克，住進加護病房之護理經驗，筆者於2015年4月9日至2015年4月11日，運用Gordon十一項健康功能型態評估，以觀察、會談、身體評估等方式進行資料收集，確立護理問題有：心輸出量減低、焦慮、知識缺失。護理過程中，經密切監測血液動力學之變化以維持生命徵象穩定，使其成功脫離輔助循環；採主動關懷、陪伴、鼓勵表達並引導個案抒發內心焦慮感受；主動提供疾病相關訊息，運用個別性的護理衛教指導，增進日後自我照護能力。建議對於此類病患，可透過在職教育教導護理人員，藉由簡單的按摩促進舒適概念，並緩解焦慮情緒，希望藉此護理經驗，提供照護此類病患之參考。

This article described an intensive care nursing experience of a 65-year-old female patient with myocardial infarction complicated by cariogenic shock. The nursing period lasted from April 9^(th) to 11^(th), 2015. Gordon's eleven functional health patterns were applied to assess the data collected via observation, interview, and physical evaluation, and the following nursing issues were established: cardiac output reduction, anxiety, and knowledge deficit. During the nursing period, hemodynamic monitoring was performed to keep the patient's vitals stable, and allowed the patient to successfully weaned from assisted circulation. Through active care and companionship, the patient was encouraged to express her inner anxiety. To enhance the patient's self-care ability after discharge, the author actively provided disease related information and organized individualized health education. When faced with patients with similar conditions, nursing staff can acquire simple massage ability through continuing education to relieve the patients' anxiety. We hope that this nursing experience can serve as a reference when facing patients with similar conditions.

1. Niebauer, J.,Mayr, K.,Harpf, H.,Hofmann, P.,Muller, E.,Wonisch, M.,Benzer, W.(2014).Long-term effects of outpatient cardiac rehabilitation in Austria: A nationwide registry.Wien Klin Wochenschr,126(5-6),148-155.
2. Steg, P. G.,James, S. K.,Atar, D.,Badano, L. P.,Blomstrom-Lundqvist, C.,Borger, M. A.,Zahger, D.(2012).ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.European Heart Journal,33(20),2569-2619.
3. 林世宗,呂炎原,徐漢仲(2013)。心肌梗塞之重新定義與臨床分類。內科學誌，24(1)，1-11。
4. 林瑞英(2013)。一位急性心肌梗塞病併發心因性休克病人之護理經驗。馬偕護理雜誌，7(1)，94-102。
5. 胡倩青,林夷真(2012)。心肌梗塞之焦慮改善專案。寶建醫護與管理雜誌，10(1)，34-44。
6. 胡倩青,林夷真,林明正,韓若平(2013)。音樂治療對心肌梗塞病患之焦慮程度及生理反應之成效。長庚護理，24(4)，357-364。
7. 歐羽珊,陳淑媚,袁玉萍(2011)。一位心因性休克和併使用主動脈內氣球幫浦病人之加護經驗。源遠護理，5(2)，63-71。
8. 衛生福利部(2015，9月22日) ·死因統計·取自http://www.mohw.gov.tw/news/531652300

1. 蔡瑛芷,曾麗卿,陳靜儀(2021)。一位紅斑性狼瘡患者併發心肌梗塞之護理經驗。彰化護理，28(1)，57-69。