照護一位僧帽瓣狹窄併發急性肺水腫孕婦面臨胎兒死亡之護理經驗

The Nursing Experience of Taking Care of Pregnancy Woman Diagnosed with Mitral Stenosis Combined with Acute Pulmonary Edema and Fetal Death

本文在描述一位懷孕26週因僧帽瓣狹窄引發急性肺水腫的孕婦，在加護病治療房期間面臨插管治療及胎兒死亡的護理經驗。個案護理期間自2008年11月24日至2008年12月3日，筆者使用Gordon十一項功能性健康型態評估，運用實際觀察、深入會談、筆談、傾聽、病歷查閱及身體評估等技巧進行資料收集，歸納個案之健康問題為心輸出量減少、氣體交換障礙及哀傷功能失常等護理問題。護理過程中筆者密切觀察心輸出量減少之臨床表徵，持續監測血液動力學變化，配合藥物治療及醫療處置，改善心輸出量減少症狀，減輕個案之不適。拔除氣管內管後教導個案運用噘嘴式呼吸促進二氧化碳排除，增進肺部通氣改善氣體交換障礙。於插管治療期間面臨胎兒死亡，筆者不斷以紙筆與個案溝通，引導個案說出胎兒死亡之失落及內心感受，予以肯定個案懷孕過程中對胎兒的付出，減輕內心自責，運用家人之支持與關懷，協助個案接受胎兒死亡的事實，走出胎死腹中的陰霾。藉由此次護理經驗，期望能提供護理人員在照護類似病人的參考，提供身、心之整體性照護。

The article described the nursing experience of taking care of a woman who was in her 26-week pregnancy and diagnosed with mitral stenosis complicated with acute pulmonary edema and ventilator use, and faced fetal death during ICU stayed. The nursing care period was from November, 24, 2008 to December, 3, 2008. Gordon function heath status assessment tool was used to assess patient’s problems. Data were collected by direct care, communication, chart review, and physical examination. The health problems included decreased cardiac output, impaired gas exchange, and grieving dysfunctional. She was monitored observed for low cardiac output and continued hemodynamic change. The authors performed therapy appropriately and improved the patient’s symptoms. The patient was also taught Pursed Lip Breathing to help carbon dioxide expiration and to improve the pulmonary gas exchange rate. In order to comfort the patient’s loss of a child during during ventilator dependence period, she was encouraged to express the feeling of fetal death by writing. Empathy and mental support were used to relieve patient’s guilt about fetal loss. The unique nursing experience can be a reference for caring similar patients in the future.