照顧一位老年憂鬱自刎個案之加護經驗

The Intensive Nursing Experience of a Suicidal Elderly Depression Patient

10.6530/YYN.202209_16(S).0005

張夢寰(Meng-Huan Chang)；羅雅芬(Ya-Fen Lo)

老年憂慮 ； 加護護理經驗 ； 低效性呼吸型態 ； elderly depression ； nursing experience in icu ； inefficient breathing pattern

源遠護理

16卷增訂刊（2022 / 09 / 01）

33 - 39

繁體中文

本文個案為86歲女性拿菜刀自刎，術後轉至加護病房觀察，期間及時發現氣胸及皮下氣腫引發低效性呼吸型態，經過緊急治療後病況穩定，後續照護面臨到個案喪偶後產生的憂鬱引發無效性因應行為，個案的經歷激發筆者欲深入探討的動機。護理期間自2018年5月13日至5月25日，筆者運用Gordon十一項功能性健康型態評估方式，綜整個案生理及心理問題包含低效性呼吸型態／肺擴張不全、組織完整性受損／外傷性傷口及術後傷口與無效性因應能力／無法接受配偶死亡等，透過急性期的呼吸照護協助個案儘早脫離呼吸器，提供完善的傷口照護，透過指標性策略介入，避免個案再次自傷，運用陪伴及關懷，讓個案道出內心感受，並協助家屬了解個案面臨的心理問題，期望藉由此次照護經驗的分享，能更瞭解老年憂鬱及自傷病人的身、心、靈變化，提供適切的照護。

This article describes an intensive nursing experience of an eighty-six years old women who committed suicide by using knife to cut her own throat. After the surgery, she was transferred to intensive care unit for further observation. In the intensive care unit, she experienced pneumothorax and subcutaneous emphysema. After a series of medical intervention, her condition became stable. During the nursing process, the author encountered the patient's ineffective coping due to her depression. This motivated the author to study the case in depth. The nursing period was from May 13, 2018 to May 25, 2018. The author used Gardon's ＂11 Functional Health Patterns Assessment＂ as a tool for nursing assessment. After the patient's physical and mental issues were identified, nursing interventions were provided accordingly. The identified major healthcare problems were ineffective breathing pattern, impaired tissue integrity and ineffective coping skills.To prevent the patient from hurting herself again, the author utilized the indicated prevention. The author accompanied the patient with mental support and successfully helped the patient express her feelings to her family and the author. Finally, the author assisted the family to manage the patient's mental issue, and helped arrange an adequate respiratory care ward to the next sequence of care. The author expects to share this nursing experience as a reference to nursing elderly patients with depression and similar situations.

1. Bowling, W. M.,Wilson, R. F.,Kelen, G. D.,Buchman, T. G.(2003).Thoracic trauma.Tintinalli’s Emergency Medicine,6(1),1675-1677.
2. Brooks, S. E.,Burruss, S. K.,Mukherjee, K.(2019).Suicide in the elderly: A multidisciplinary approach to prevention.Clinics in Geriatric Medicine,35(1),133-145.
3. Diggle-Fox, B. S.(2016).Assessing suicide risk in older adults.Nurse Practitioners,41(10),28-35.
4. Hsu, C. W.,Sun, S. F.(2014).Iatrogenic pneumothorax related to mechanical ventilation.World Journal of Critical Care Medicine,3(1),8-14.
5. Kok, R. M.,Reynolds, C. F.(2017).Management of Depression in Older Adults: A Review.Jama,317(20),2114-2122.
6. Madden, B. P.(2017).Evolutional trends in the management of tracheal and bronchial injuries.Journal of Thoracic Disease,9(1),67-70.
7. Nazarko, L.(2018).Choosing the correct wound care dressing: An overview.Journal of Clinical Nursing,32(5),42-52.
8. Tavares, A. C.,Araujo, P. N.(2017).Practical aspects about closed chest drainage care: A literature review.Journal of Physiotherapy Research,7(2),298-307.
9. 衛生福利部（2020，11月27日）．全國自殺死亡資料統計．取自https://dep.mohw.gov.tw/domhaoh/cp-4904-8883-107.html
10. 鄭偉伸,黃宗正,李明濱,廖士程(2016)。老人憂鬱症與自殺防治。台灣老年醫學暨老年學雜誌，11(1)，16-30。