運用歐倫理論照顧急性心肌梗塞併發心因性休克病人之加護經驗

The Intensive Nursing Care Experience of Orem Self-Care Theory to a Patient with Acute MyocardiaI Infarction Complicated with Cardiogenic Shock

台灣地區每年約有一萬至兩萬人罹患急性心肌梗塞，由於大部分患者易出現心律不整合併症，若未及時處理，將提高死亡率，故具備重症照護與敏銳觀察力對於照護此類個案是重要的。本個案報告描述首次因急性心肌梗塞併發心因性休克病人之照護經驗，筆者採用歐倫自我照顧理論為護理評估架構，針對問題擬定計畫、評值，於2008/4/12至2008/4/20護理期間進行觀察、會談、健康史、身體評估，發現個案有因冠狀動脈血流灌注減少造成心輸出量減低；因擔心自己疾病變化及預後而有無望感；個案及家屬對疾病照護能力不足而有無效性健康維護能力問題。作者於加護病房護理期間提供主動脈氣球幫浦照護，提升個案心輸出量，維持良好氧合能力，藉由關懷個案，建立良好護病關係，並陪伴、鼓勵個案及家屬主動表達情緒，使個案能積極面對疾病與治療過程，另鼓勵家屬使用觸摸技巧及宗教信仰介入，祈求內心平安與心靈慰藉，照護期間教導個案及家屬提升心肌梗塞自我照顧能力，儘早提供個案肢體活動計劃，增加病人身體功能，以連續性、個別性及整體性的評估與照顧，使個案早日轉出加護病房並順利出院。期望透過此次照護經驗，及運用家庭支持系統介入，持續追蹤疾病進展，使個案擁有良好的生活品質。About 10000 to 20000 people suffer from acute myocardial infarction (AMI) each year in Taiwan. If arrhythmia, a common complication of AMI, is not treated promptly, the mortality rate will increase. This case report describes a case of AMI complicated with cardiogenic shock. The Orem Self-Care Theory was used to guide the nursing assessment and plan the nursing care. During the nursing care period starting from April 12 to April 20, 2008, three health problems were identified, including decreased cardiac output, hopelessness, and ineffective health maintenance. The patient received an intra-aortic balloon pump to maintain cardiac output and oxygenation. A good therapeutic patient-nurse relationship was established and the patient was able to face the disease and the treatment process with a positive attitude. The family was encouraged to use 'touch' techniques and religious support to increase the patient's level of psychological well-being. Self-care management education was provided to the patient and the family. Early mobilization and limb exercise were employed to increase the patient's physical functioning. The patient was able to transfer to the ward and discharged from the hospital.