初次罹患急性心肌梗塞併發心律不整病人之急診護理經驗－個案報告

An Emergency Nursing Experience in a Patient with Initial Risk of Acute Myocardial Infarction Complicated by Arrhythmia: A Case Report

10.6200/TCMJ.2014.11.1.12

王郁菁(Yu-Jing Wang)；林翠娟(Tsui-Chuan Ling)；李妙粉(Miao-Fen Li)；陳淑暖(Shu-Nuen Chen)

初次心肌梗塞 ； 心律不整 ； 急性疼痛 ； 焦慮 ； Initial myocardial infarction ； arrhythmia ； acute pain ； anxiety

北市醫學雜誌

11卷1期（2014 / 03 / 30）

112 - 120

繁體中文

本文描述一位45歲男性因急性心肌梗塞併發心律不整之急診護理經驗。運用Gordon十一項功能性健康評估，藉由身體評估、觀察、會談及直接照顧等方法收集資料，發現病人有心肺組織灌流改變、急性疼痛、焦慮等護理問題。經監測組織灌流不足症狀及心電圖變化、氧氣及血管擴張劑使用；協助舒適臥位及放鬆技巧運用；探視並鼓勵病人說出對疾病問題感受、鼓勵家人陪伴、教導急性心肌梗塞相關知識。結果病人於急診期間血液動力學穩定及血氧飽和度達95%以上；能執行三種有效減輕疼痛的方法且疼痛指數降至2分；能主動說出急性心肌梗塞的危險因子、症狀等，並正向思考自己病情，進而同意接受經皮冠狀動脈介入治療。

This report describes a nursing experience of caring a 45-year-old male with acute myocardial infarction with arrhythmia in emergency care unit. The nursing assessment data was collected by physical assessments, interviews and observations. The nursing-related issues, including changes in cardiopulmonary tissue perfusion, acute pain and anxiety, were then identified by using Gordon's 11 functional health patterns assessment. In addition to monitoring the symptoms of inadequate tissue perfusion, changes over electrocardiogram, use of oxygen and vessel dilators, listening, humanized solicitude, spiritual care, family stress model nursing, as well as relaxation treatment were also applied. The investigator also provided knowledge of cardiac rehabilitation to the patient. As a result, his hemodynamic status was stabilized and pain scores decreased. He could take initiative to tell his ideas, concerns and that his anxiety had been reduced. Besides, he could mentioned his acute myocardial infarction risk factors, symptoms and complications, and had confidence and positive thinking on the progress of the disease. Further, he agreed to accept percutaneous coronary intervention treatment.