照顧一位冠狀動脈心臟病併發肺積水病患之經驗

A Nursing Experience with a Patient with Pulmonary Edema Combine to Coronary Heart Disease

本文描述照護一位74歲女士，因冠狀動脈心臟病併發肺積水住於加護病房中之護理經驗，照護期間為2008年6月28日至2008年7月3日。藉由會談、觀察及身體評估技巧收集資料，以Gordon 11項功能性健康型態評估，確立個案護理問題為活動無耐力、焦慮、便秘、睡眠型態紊亂，運用專業知識和提供個別性護理，並透過個案、家屬、醫療小組合作，使個案呼吸喘症狀得到緩解之外，也降低住院期間的焦慮與不安，並增加睡眠時間，也緩解因住院期間絕對臥床休息及身體活動受限制造成之便秘問題。冀望本篇個案報告能作為日後執行臨床照護之參考。

This article described a nursing experience with a 74-year-old patient with coronary heart disease. The patient was admitted to the intensive care unit due to pulmonary edema Combine to coronary heart disease. The period of nursing care was from June 28 to July 3, 2008. Through active listening, an interview, a physical examination, and Gordon's 11 functional health assessment, the data were collected and the nursing problems were identified. They included activity intolerance, anxiety, constipation, and sleep pattern disorders. The author provided individualized care to the patient through professional nursing knowledge and collaborative work with the medical team. The patient's asthmatic symptoms were relieved. The patient's anxiety during hospitalization was reduced and sleep time was increased. The patient's constipation due to absolute bed rest and restrictive physical activity was resolved. This article is a reference for nurses taking care of ICU patients with pulmonary edema Combine to coronary heart disease.