一位初入加護病房之腸胃道出血併休克患者的照護經驗

A Nursing Experience with an ICU Patient with Shock Secondary to GI Bleeding

本篇報告是照顧一位雙眼幾近全盲、罹患腸道出血併休克病人的護理經驗，個案因糖尿病導致視力變差，且因初次住進加護病房，面對陌生的環境感到恐懼害怕、無助等心理問題，因此拒絕一切的醫療行為，筆者運用Gordon十一項健康功能型態評估，發現個案主要問題為：焦慮、疼痛、組織灌流改變－腸胃道。在照護期間筆者協助確認其焦慮源，運用有效因應技巧協助個案減輕焦慮，以接受必要性治療，並教導個案採用放鬆、減緩疼痛強度的方法減輕疼痛；針對個案體液組織灌流不足，首先依醫囑以靜脈管道補充液體維持生命徵象穩定，在禁食期過後，安排攝取適當食物，使個案營養狀況改變，問題順利解決，藉由提供個別化護理措施，使病人的存活能達到最佳的功能狀態。

This article discussed the experience of providing nursing care to a nearly blind ICU patient with shock secondary to GI bleeding. With fear of the strange ICU environment and feeling of helplessness due to blindness, this patient refused all medical interventions. Based on the application of Gordon Health Functional Assessment, the author concluded that the major problems this patient experienced were anxiety, pain, and poor tissue perfusion. The author assisted the patient with identifying the causes of anxiety and helped reduce anxiety through coping skills. The author also educated the patient about the effective methods of relaxation to alleviate the patient's pain. With an improvement in pain and anxiety, the patient accepted all necessary treatments. Perenteral nutrition supplement stabilized patient's vital signs and tissue perfusion. Suitable diet adjustment solved the patient's problem of poor nutrition. Individualized nursing care not only helped the patient survive, but also helped the patient achieve best physical, psychological, emotional, and social function status.