一位急性心肌梗塞個案初次入住加護病房之護理經驗

Nursing Experience of a First Suffering Acute Myocardial Infarction Case in an Intensive Care Unit

蔡伊婷(Yi-Tin Tsai)；許郁卿(Yu-Chin Hsu)

急性心肌梗塞 ； 加護護理 ； 家屬照護 ； acute myocardial infarction(AMl) ； nursing in intensive care unit(lCU) ； education of families

若瑟醫護雜誌

10卷1期（2016 / 07 / 01）

71 - 84

繁體中文

本文為照護一位50歲男性初次罹患急性心肌梗塞，同時行冠狀動脈氣球擴張術後，因病情需要入住加護病房之護理經驗。筆者於2013年5月17日至5月22日護理期間運用全人照護模式為指引，以觀察、會談、病歷報告、理學檢查與健康評估等方式收集資料，整理並分析後確立護理問題有：心輸出量減少、焦慮及照顧者角色緊張等。護理期間個案除疾病所產生生理問題外，更因面對初次急性心肌梗塞與入住加護病房而焦慮不安。筆者先與個案建立良好護病關係，再以同理、關懷、陪伴、正向鼓勵，適時關心其需求與提供多媒體之護理指導；執行各項醫療處置、除改善其生理問題外，亦降低了焦慮不安、促進睡眠與舒適；進而使個案主動表達內心成受，以積極、正向態度調適疾病衝擊，學習自我照顧以提昇生活品質；同時緩解主要照顧者情緒壓力，教導照護技巧，落實以家庭為中心之護理，最終使個案順利轉出加護病房，進而出院返家。

This nursing experience describes a 50 years-old man suffering from acute myocardial infarction (AMI) for the first time after receiving percutaneous transluminal coronary angioplasty (PTCA) in intensive care unit (ICU). He faced life threats, physical discomfort, strange environment, and separation from his family. The nursing period is from 17 to 22, May, 2013.We used holistic model, observed, conversations, medical reports, physical examination and health assessment to collect data. After organization and analysis, we established nursing problems as followings: cardiac output reduction, anxiety and caregiver role strain. During the nursing period, we not only reduced patient's physical illness resulting from discomfort but also the anxiety of first suffering from AMI and admitted in strange ICU. We established good nurse-patient relationship initially and applied the empathy, companionship, positive encouragement, multimedia nursing instruction and medical treatments to caring the patient. We not only resolved physical problems but also alleviated anxiety, promoted sleeping quality. We encouraged patient's initiative to express feelings with positive attitude adaptation of disorders impacting and learning of self-care skills. By alleviating caregiver emotional stress, hearing feelings and teaching care skills with implementation of family-centered care, he eventually successfully discharged from ICU and general ward.

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