一位急性心肌梗塞併心因性休克中年病人撤除維生醫療決策之護理經驗

Nursing Experience of Withdrawing Life Support from a Middle-Aged Patient with Cardiogenic Shock

翁于茜(Yu-Chien Weng)；林荷璇(Ho-Hsuan Lin)；趙心瑜(Hsin-Yu Chao)；陳幸眉(Hsing-Mei Chen)；蘇淑貞(Shu-Chen Su)

急性心肌梗塞 ； 心因性休克 ； 預期性哀傷 ； 撤除維生醫療 ； anticipatory grieving ； cardiogenic shock ； myocardial infarction ； withdrawal of life-sustaining treatment

志為護理-慈濟護理雜誌

22卷2期（2023 / 04 / 01）

116 - 128

繁體中文;英文

本文描述一位急性心肌梗塞併心因性休克的中年重症病人移除維生系統死亡之護理經驗。護理期間於2019年11月12日至11月30日，藉身體評估、病歷查閱、與醫療團隊討論和家屬會談收集資料，確立護理問題：心輸出量減少、預期性哀傷、撤除維生醫療決策。護理措施，在病人方面以維持血液動力學穩定為主要治療目標；在家屬方面，開放彈性會客、引導個別家屬表達情緒、傾聽及照會安寧共同照護團隊，並安排撤除維生醫療家庭會議，家屬最終達成撤除維生醫療的決議。期望此個別性照護經驗，能提供護理人員於未來照護類似病人時之參考。

This article describes the author's experience of providing nursing care for a middle-aged critically ill patient with acute myocardial infarction and cardiogenic shock who died after his life support was removed. The nursing care was provided from November 11th to 30th, 2019. Data was collected using physical assessments, chart reviews, discussions with the medical team, and interviews with the family. Three health problems were identified: low cardiac output, anticipatory grieving, and decision-making on withdrawing life-sustaining treatment. The nursing intervention included two parts: for the patient, maintaining hemodynamic stability was the main outcome of the treatment; and for the families, the nursing intervention included providing flexible visiting hours, encouraging the expression of emotions, listening to their worries and concerns, and consulting the palliative care team and arranging a family meeting to discuss the withdrawal of life-sustaining treatment. Finally, the decision of withdrawing life-support was made by the family. This nursing care experience can provide a reference for nurses' caring for patients and their families who are facing unexpected death and anticipatory grieving in the future.

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