照護一位急性心肌梗塞合併心因性休克接受冠狀動脈繞道手術後患者之護理經驗

The Nursing Experience of A Patient with Acute Myocardial Infarction and Cardiogenic Shock who Received Operation of Coronary Artery Bypass Graft

本篇個案報告主要是描述照護一位急性心肌梗塞病患因歷經心因性休克，緊急進行冠狀動脈繞道手術之護理經驗。由於病程進展快速，使個案面臨生命極大的威脅，其生理、心理及社會層面皆承受極大的壓力，筆者於2008年1月16日至1月25日照護期間，藉由觀察、訪談，運用羅氏適應模式評估，確立主要健康問題為：心輸出量不足、高危險性損傷、急性疼痛、高危險性感染與焦慮等，在照護期間有效運用護理過程，密切觀察血液動力學數值之變化，維持穩定的生命徵象並成功脫離主動脈內氣球幫浦，渡過心臟手術之危險期，同時運用關懷、傾聽同理個案的感受，協助個案面臨突如其來的生命劇變，克服心裡的不安、恐懼及手術後的不適，故期盼藉由此護理經驗提供同仁在臨床照護上之參考，藉以提升護理品質。

This case report described the nursing experience of a patient with acute myocardial infarction with cardiogenic shock who underwent emergent Coronary Artery Bypass Graft (CABG) surgery. The fast progression posed a serious threat to the patient’s life and thus, caused physical, mental, and social stress to the patient. During January, 16 to 25 of 2008, the author used the Roy’s Adaptation Model of Nursing to evaluate this patient. The main health problems included decreased cardiac output, high risk of injury, acute pain, high risk of infection, and anxiety. With the help of effective nursing process, close monitoring of hemodynamic state, and maintaining the vital signs stable, the patient passed the critical stage of post-operation time and weaned from IABP support successfully. We also used a supportive system to help the patient face the sudden drastic changes of his life and overcome his physiological and psychological reaction. We would like to share this nursing experience with all colleagues and hope this could be helpful for the promoting nursing quality.