照顧一位心臟移植術後病人的加護護理經驗

The Intensive Nursing Care for a Patient Post Heart Transplantation

本文敘述筆者於加護病房內協助一位心臟移植術後病人解決術後所引發的生理、心理相關護理問題的過程。於照護期間（2005年4月29日至5月8日），以羅氏適應模式為評估指引來收集資料，發現病人長期因心衰竭反覆入院治療，此次期望能藉心臟移植改善心臟功能。但術後病人面臨心臟功能恢復期間短暫的功能降低及服用藥物增加表現消極且被動，而呈現出無力感的現象，且併有潛在危險性感染、急性疼痛等護理問題。在護理過程中運用多層面之護理措施，藉由良好的支持系統，鼓勵及陪伴個案，引導其抒發負向情緒感受，以正向態度面對此手術，進而緩解其無力感並增強自我控制感。希望藉此護理經驗提供護理同仁照護類似病人時，除了減輕病人術後之身體不適，亦教導病人心臟移植術後之自我照顧，以提升其生活品質。

This case report described the nursing experience of caring for a patient post heart transplantation in an intensive care unit. During the caring period (from 4/29/2005 to 5/8/2005), the author assessed the patient’s health problems by Roy’s model and confirmed that the patient, after being hospitalized for congestive heart failure several times, hoped to improve her cardiac function by this heart transplantation operation. The patient suffered from decreased cardiac output and increased drug used. A passive and depressed attitude and a sense of helplessness were noted, combining with potential risk of infection and acute pain. The multiplex process of nursing was used to encourage the patient to take advantage of her strong support system, to express her negative feelings, and to be optimistic about this major surgery further to decrease her sense of helplessness and improve self-control. The paper emphasized the importance of self-care education on post heart transplantation.