照護一位老年憂鬱症患者服用鈣離子阻斷劑自殺之護理經驗

Nursing Care Experience of a Patient with Elderly Depression Who Attempted Suicide Using Calcium Channel Blockers

鄒宗泰(Tsung-Tai Tsou)；林貴滿(Kuei-Man Lin)

老年憂鬱症 ； 鈣離子阻斷劑 ； 自殺企圖 ； calcium channel blockers ； elderly depression ； suicide attempt

志為護理-慈濟護理雜誌

19卷4期（2020 / 08 / 01）

102 - 112

繁體中文

本文探討一位86歲患有老年憂鬱症個案，因下肢無力產生強烈無望感，故服用大量鈣離子阻斷劑自殺之急診加護護理經驗。照護期間自2017年8月2日至8月7日，筆者運用五大層面評估，藉由實際觀察、會談、傾聽、身體評估、查閱電子病歷等方式蒐集資料，確認個案有心輸出量不足、無望感、無效性因應能力等健康問題。護理過程中藉由解毒劑及昇壓劑維持生命徵象，病況穩定後運用傾聽、同理心，引導及鼓勵個案說出自殺原因、想法與感受，並轉介心理諮詢、精神科、社工等團隊，協助個案克服生活中的壓力事件，改善無望感、解除自殺危機。透過此照護經驗分享，期盼除了緊急救護及生理處置外，能兼顧心理、靈性及社會之照護，讓護理更具完善。

The nursing care experiences of an 86-year-old man with elderly depression. His lower limbs were weak, and he required assistance for daily activities. He experienced a strong sense of hopelessness and attempted suicide by ingesting large quantities of calcium channel blockers. He was admitted to the emergency intensive care unit. The period of care was from August 2, 2017, to August 7, 2017. The author collected information in five major areas through observation, interview, listening, physical examination, and chart review. The major problems observed during hospitalization were decreased cardiac output, hopelessness, and inability to cope. During the nursing process, we administered antidotes and inotropic agents to maintain vital signs. After we stabilized the patient's condition, we listened to and communicated with him, offering empathy and care. Encouraged to express negative feelings and reasons for feeling suicidal, the patient was helped to overcome stress, reduce hopelessness, and avert a suicide crisis with the help of social workers, a psychological team, and psychological counselors. Through this sharing of care experiences, psychological, spiritual, and social care can be used to achieve a more comprehensive nursing approach.

1. 卜心怡,游雅梅(2017)。照顧一位腦中風後無望感患者之護理經驗。榮總護理，34(1)，49-56。
   連結：
2. 侯銘峰,林岱樺,黃麗華(2017)。一位瀰漫性血管內凝血併無望感個案之急診護理經驗。新臺北護理期刊，19(2)，85-94。
   連結：
3. 梁明玉,柯莉珊,鄭慧娟,林麗華(2017)。照護一位獨居頻跌且無望感榮民之經驗。榮總護理，34(2)，196-206。
   連結：
4. 陳正翰,廖婉如(2017)。鈣離子阻斷劑中毒的處置。臨床醫學月刊，80(1)，389-393。
   連結：
5. 廖士程,李明濱,龍佛衛,張家銘,吳佳儀(2015)。台灣自殺防治十年回顧檢討與展望。台灣公共衛生雜誌，34(3)，227-239。
   連結：
6. 劉慕恩,楊誠弘(2017)。老年憂鬱症回顧。臨床醫學月刊，79(2)，69-71。
   連結：
7. Gana, K.,Bailly, N.,Broc, G.,Cazauvieilh, C.,Boudouda, N. E.(2017).The geriatric depression scale: Does it measure depressive mood, depressive affect, or both?.International Journal of Geriatric Psychiatry,32,1150-1157.
8. Lee, H.,Seol, K. H.,Kim, J. W.(2018).Age and sex-related differences in risk factors for elderly suicide: Differentiating between suicide ideation and attempts.International Journal of Geriatric Psychiatry,33(2),e300-e306.
9. Maskell, K. F.,Ferguson, N. M.,Bain, J.,Wills, B. K.(2017).Survival after cardiac arrest: ECMO rescue therapy after amlodipine and metoprolol overdose.Cardiovascular Toxicology,17(2),223-225.
10. St-Onge, M.,Anseeuw, K.,Cantrell, F. L.,Gilchrist, I. C.,Hantson, P.,Bailey, B.,Megarbane, B.(2017).Experts consensus recommendations for the management of calcium channel blocker poisoning in adults.Critical Care Medicine,45(3),306-315.
11. St-Onge, M.,Dube, P. A.,Gosselin, S.,Guimont, C.,Godwin, J.,Archambault, P.,Blais, R.(2014).Treatment for calcium channel blocker poisoning: A systematic review.Clinical Toxicology,52(9),926-944.
12. World Health Organization (WHO). (2017) . Depression. Retrieved from http://www.who.int/mediacentre/factsheets/fs369/en/
13. 內政部統計處(2018年1月)．內政部統計年報-人口年齡分配．取自https://www.moi.gov.tw/files/site_stuff/321/2/year/year.html
14. 台灣自殺防治中心(2017年6月23日)．新聞媒體聯繫會議－老人自殺防治：問題與挑戰．取自http://tspc.tw/tspc/portal/news/content.jsp?type=news&sno=1001
15. 吳佩霖(2017)。Amlodipine中毒之處置：案例報告。秀傳醫學雜誌，16(1)，40-45。
16. 張彩秀,樓美玲,譚蓉瑩,吳昭軍,吳寶琴(2013)。健康促進計畫對防治社區老人憂鬱症狀之成效探討。澄清醫護管理雜誌，9(4)，29-36。
17. 陳亭余,高啟雯(2009)。心輸出量減少病患之護理。長庚護理，20(3)，319-326。
18. 鄭偉伸,黃宗正,李明濱,廖士程(2016)。老人憂鬱症與自殺防治。台灣老年醫學暨老年學雜誌，11(1)，16-30。