一位肺栓塞病人之照護經驗

Experience of Caring for a Patient with Pulmonary Embolism

吳翌維(Yi-Wei Wu)；方雀蓮(Chueh-Lien Fang)

深部靜脈栓塞 ； 肺栓塞 ； 心肺組織灌流改變 ； 疼痛 ； 焦慮 ； deep vein thrombosis ； pulmonary embolism ； anxiety

若瑟醫護雜誌

18卷1期（2024 / 06 / 01）

142 - 154

繁體中文;英文

本文個案為一位因深部靜脈栓塞導致肺栓塞，緊急接受血栓溶解劑治療之加護病房護理經驗。照護期間自2021年5月15日至5月20日，透過觀察、身體評估、會談等技巧收集資料，並運用Gordon十一項健康功能型態進行評估，確認主要的健康問題包含：心肺組織灌流改變／與肺栓塞影響心肺循環有關；疼痛／與左膝膕深部靜脈栓塞及左下肢水腫造成局部壓迫有關；焦慮／與對疾病及藥物治療預後不確定及擔心抗凝血劑潛在出血副作用有關。護理過程中運用關懷及同理心傾聽個案需求，並運用專業知識給予協助及心理支持，減輕個案因擔心服用抗凝血劑的潛在副作用之焦慮情緒；穩定血液動力學與氧合，積極預防使用血栓溶解劑常見合併症，繼而穩定轉出加護病房。肺栓塞患者在痊癒出院後，多數會併發肺高壓影響生活品質，建議後續有個管師介入安排肺部復原運動訓練，以提升運動耐力與改善健康狀態。希望藉此照護經驗分享，提升肺栓塞個案之整體照護品質。

This study investigates the nursing experience of caring for a patient with pulmonary embolism caused by deep venous thrombosis, who was urgently treated with thrombolytic agents due to life-threatening situation. The patient was successfully transferred out of the intensive care unit after the joint care of the medical team. The nursing care period was from May 15 to May 20, 2021. The author used skills such as observations, physical assessment, and interviews to collect data. In addition, this study also used Gordon's 11 Functional Health Patterns to perform the assessment and confirmed that the main health problems included: change in cardiopulmonary tissue perfusion, which was associated with the gas exchange disorder and reduced cardiac output caused by pulmonary embolism; pain, which was associated with the deep popliteal vein thrombosis in the left knee and local compression caused by edema in the left lower limb; anxiety, which was associated with the uncertainty about disease and drug therapy and potentially dangerous bleeding caused by anticoagulant drugs. During the nursing process, the author used care and empathy to listen to the needs of the patient, as well as used professional knowledge to provide assistance and psychological support to alleviate the patient's anxiety caused by the side effects of taking anticoagulant agents, maintain stable hemodynamics and oxygenation, and actively prevent the occurrence of common complications caused by the use of thrombolytic agents. The cardiopulmonary function of patients with pulmonary embolism still will be affected after recovery, which will further result in pulmonary hypertension and affect their quality of life. In addition to improving medication compliance, case managers are advised to arrange the subsequent pulmonary rehabilitation exercise training programs for patients to improve exercise endurance, health status, and quality of life. Hopefully, the sharing of this care experience may help improve the quality of care for patients with pulmonary embolism.