一位紅斑性狼瘡患者併發心肌梗塞之護理經驗

The Nursing Experience of Lupus Erythematosus Patient with Myocardial Infarction

10.6647/CN.202103_28(1).0007

蔡瑛芷(Ying-Chih Tsai)；陳靜儀(Ching-Yi Chen)；曾麗卿(Li-Ching Tseng)

紅斑性狼瘡 ； 心肌梗塞 ； 焦慮 ； lupus erythematosus ； myocardial infarction ； anxiety

彰化護理

28卷1期（2021 / 03 / 01）

57 - 69

繁體中文

本文描述一位26歲紅斑性狼瘡病人因下肢水腫、關節疼痛入院，住院期間併發心肌梗塞之護理經驗。筆者於2018/11/13至11/24護理期間藉由觀察、會談、直接照護及運用羅氏適應模式進行整體性評估，發現個案有體液容積過量、組織灌流改變及焦慮等健康問題。護理過程中筆者與個案建立良好的治療性關係，密切監測體液變化，教導飲食及水分攝取重點；針對心肌梗塞提供心導管術後相關照護衛教，運用護理知識及醫療團隊合作，追蹤個案紅斑性狼瘡及心肌梗塞病情變化，緩解個案不適；以陪伴、傾聽讓其說出對疾病感受及自身想法，鼓勵積極參加治療計劃，並提供紅斑性狼瘡與心肌梗塞的疾病護理，協助個案增加照護知識，減輕不安、焦慮，最終使其適應身心狀態的變化，正向迎接未來。紅斑性狼瘡臨床表現多樣化，臨床上對於疾病照護認知多聚焦於脈衝治療與腎炎；但年輕個案併發心肌梗塞造成的心理衝擊，需護理師提供情緒支持與轉介，建議單位可舉辦疾病照護認知與常見心理衝擊，增加護理人員疾病照護認知、心靈評估及情緒支持的技巧，早期偵測，早期提供照護與適當轉介專業人員，期藉此經驗提供照護參考。

This paper describes the nursing experience of a 26-year-old lupus erythematosus patient with lower extremity edema and joint pain who developed myocardial infarction during hospitalization. During the nursing period from November 13 to November 24, 2018, the author conducted a holistic assessment through observation, interviews, direct care, and the use of Roy's adaptation model, and found that the case had health problems such as excessive fluid volume, changes in tissue perfusion, and anxiety. The author establishes a good therapeutic relationship with the case, closely monitors the changes in body fluids, teaches the key points of diet and water intake; provides relevant care and health education after cardiac catheterization for myocardial infarction, uses nursing knowledge and medical team cooperation to track cases of lupus erythematosus and myocardium changes in the infarct condition, alleviating the discomfort of the case; accompany them and listen to let them express their feelings about the disease and their own thoughts, encourage active participation in the treatment plan, and provide disease care for lupus erythematosus and myocardial infarction, and assist the case to increase care knowledge, reduce anxiety, anxiety eventually makes it adapt to changes in the physical and mental state, and is welcoming the future. The clinical manifestations of lupus erythematosus are diverse, and it is not common for young patients with lupus erythematosus complicated with myocardial infarction. The cognition of disease care is mainly focused on pulse therapy and nephritis. The change of disease condition also causes the psychological impact on patients, which needs emotional support and referral from nurses. It is suggested that the unit can organize disease care cognition and common psychological impact to increase nursing staff's awareness of disease care In order to provide a reference for nursing, we should use the skills of psychological assessment and emotional support, early detection, early care, and appropriate referral to professionals.

1. 張麗君,胡真珍(2018)。照護一位初次罹患急性心肌梗塞病患之加護經驗。志為護理─慈濟護理雜誌，17(4)，127-136。
   連結：
2. 蔣昀孜,葉美玲,劉介宇(2018)。呼吸放鬆改善中風病人自律神經、疲憊、焦慮、壓力與生活品質之成效。長庚護理，29(3)，325-336。
   連結：
3. Lam, N. C.,Ghetu, M.V.,Bieniek, M. L.(2016).Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.American Family Physician,94(4),284-294.
4. Nailu, A. S.,Priscila, A.,Simone, A.(2013).Risk factors in cardiovascular disease in systemic lupus erythematosus.Current Cardiology Reviews,9(1),15-19.
5. Sayhi, S.,Gueddich, N.,Dhahri, R.,Bousetta, N.,Arfaou, B.,Abdelhafidh, N. B.,Ajili, F.,Louzir, B.(2019).Non-coronary cardiac manifestations of systemic lupus erythematosus in adults: a comparative study.The pan African Medical Journal,2(33),156-160.
6. Yoon, S.,Kang, D. H.,Choi, T. Y.(2019).Psychiatric Symptoms in Systemic Lupus Erythematosus: Diagnosis and Treatment.Journal of Rheumatic Diseases,26(2),93-103.
7. 林孝義,陳玉萍,葉純宜(2014)。全身性紅斑狼瘡病人治療及護理新趨勢。榮總護理，31(2)，121-128。
8. 施淑美,吳宛真,劉麗娟,吳彥雯(2015)。心導管治療之冠心病患者的飲食及生活型態探討。台灣營養學雜誌，39(4)，112-119。
9. 胡倩青,林夷真(2012)。心肌梗塞病人之焦慮改善專案。寶健醫護與管理雜誌，15(1)，34-44。
10. 徐愬美(2017)。運用心臟復健照顧一位心肌梗塞病人之護理經驗。馬偕護理雜誌，11(1)，103-113。
11. 簡美雯,方美玲,蕭雯娟,孫美華(2014)。一位全身性紅斑狼瘡合併第四型狼瘡腎炎患者之護理經驗。長庚護理，25(2)，194-203。