一位急性心肌梗塞併發心因性休克病人之加護護理經驗

The Intensive Nursing Care Experience of a Patient with Acute Myocardial Infarction Complicated with Cardiogenic Shock

本文為照護一位因急性心肌梗塞併發心因性休克，造成心臟衰竭、肺水腫病人之加護護理經驗。筆者於護理期間藉由直接護理、觀察、會談收集病史，運用生、心、社會、靈性評估病人之健康問題，發現病人有氣體交換障礙、心輸出量減少、潛在危險性感染及害怕等護理問題。護理過程中經由增加心肌氧氣供應、減低心臟負荷、預防合併症發生、提供身心休息的環境及去除引起不安害怕的原因等護理措施，從而改善病人呼吸、循環、感染及害怕等問題。急性心肌梗塞發作之急性期，加護單位護理人員具有舉足輕重之地位，透過加護單位護理人員積極完整的評估，可早期發現問題，提供病人適切性、個別性、連續性的照護，有效改善病情，預防合併症，進而減少死亡的威脅。期望此篇個案報告能提供臨床護理人員日後照護此類病人時的參考。

This paper is to share the experience of nursing care for a patient with acute myocardial infarction complicated with cardiogenic shock, pulmonary edema and congestive heart failure in the intensive care unit. During the hospitalization period, the author had discovered that the patient had defect in oxygen exchange, decreased cardiac output, fear for death, potential risk for hospital acquired infection, and injury through direct nursing care, evaluation, and communication with the patient and his family. With increased myocardial oxygen supply, decreased cardiac loading, close monitoring of potential risk to avoid complications, and full psychosomatic support, the patient stood the critical period smoothly and the condition improved subsequently. From this experience, the author was convinced that the welltrained intensive care nursing manpower is crucial for caring patients in critical period of acute myocardial infarction. The article provided a reference for caring patients with similar condition in the future.