一位熱中暑病患之急診護理經驗

The Nursing Experience of a Patient with Heat Stroke in the Emergency Department

本報告乃描述一位56歲聾啞女士因熱中暑致突發性意識改變、體溫過高及脫水等症狀的急診護理經驗。筆者於個案在急診停留期間藉由直接護理、觀察、紙筆交談等方式收集資料，並依生理、心理、社會、靈性四方面進行評估分析，確立個案有體溫過高、體液容積缺失以及知識缺失等問題，透過全身冷水擦拭、濕毛巾覆蓋、冰敷；迅速建立輸液管道補充體液；終使個案生命徵象漸趨穩定，體溫由40.7℃降至37.1℃，意識清楚，生命徵象穩定後與個案筆談並引導家屬介入，主動衛教熱中暑相關知識，提供個案能瞭解之資訊後，個案與家屬共同學習熱中暑之相關注意事項後出院。個案離院後筆者進行電話關懷，與案子連絡追蹤3個月，個案皆未再發生熱中暑現象。透過本個案照護，期望藉由此次的護理經驗，對於日後熱中暑急症之臨床處置照護有所助益，儘早協助解決病患急性之問題外，更能深入評估及處理其他潛在的問題，以達到整體性的急診護理。

The purpose of this case study was to describe the nursing experience of a 56 year old deaf and mute female patient presenting unconsciousness, hyperthermia, and dehydration due to heat stroke. Data was collected by direct nursing care, observation, and writing interviews. The data analysis was based on the framework of physical, psychological, social and spiritual aspects. Three nursing problems were identified in this case study. They were hyperthermia, fluid volume deficit, and knowledge deficit. The provision of nursing interventions included application of cold therapies and rapid supplement of intravascular fluid. The case presented that the body temperature recovered from 40.7°C to 37.1°C, all vital signs were stable and the patient became consciousness after receiving treatments. In addition, patient education focused on the awareness and management of heat stroke provided after the patient’s condition was stabilized. The patient was follow-up by telephone interviews with her son for three months after discharge from the emergency department. The patient never had heat stroke after discharge. The nursing experience from this case study not only can enhance the ability of managing patients with heat stroke for emergency nurses, it also can improve the assessment and management of acute and potential problems related to the patient with heat stroke in order to achieve the holistic emergency nursing care.