照護一位有機磷自殺婦女病患之護理經驗

Nursing Care for an Organophosphate Poisoning Suicidal Woman

有機磷中毒在目前有日益增多的趨勢，中毒機轉影響個案病情相當迅速，且易因延遲送醫而引發中毒症狀危急生命，故具備豐富急救知識及敏銳判斷力對於照顧此類病患是非常重要。本篇報告是描述照顧一位服用有機磷自殺的個案，藉由直接護理、觀察及溝通等方式收集相關資料，確立個案有有機磷中毒之現存性損傷、個人因應能力失調等主要問題。個案住加護病房急性期間除維持呼吸道通暢及循環正常外，特別關注個案解毒劑使用後反應及反覆身體沖洗，來降低有機磷毒物對身體功能傷害的影響；再藉由關懷與個案及家屬建立良好的護病關係，以陪伴、傾聽方式，鼓勵個案主動表達心中情緒感受，建立良好的支持系統，使得個案在日後面對與家人溝通不良等壓力事件時，能主動尋求資源，學習以正向因應技巧面對問題。期望透過此個案護理經驗的分享，能提升護理人員對有機磷中毒處理應變能力，並加強對於家庭支持系統、結構之專業評估，持續追蹤病患疾病進展，協助病患獲得身、心、靈之康復，重新恢復正常生活。

The incidence of organophosphate poisoning (OPP) has increased rapidly recently. The poisoning affects the patient's condition quickly, and the patient's life can be endangered if there is a delay in transporting him to a place of treatment. Integral resuscitation knowledge and sensitive judgment are vital to patient care. The purpose of this investigation was to describe the treatment of a suicidal woman who had overdosed on organophosphate. Data were collected through the methods of direct patient care, observation, and communication, and problems were identified, such as risk of injury by organophosphate poisoning, and ineffective coping. During acute phases, the authors tried to keep the patient's airways clear, and respiration and circulation normal, and to maintain vital signs. Caregivers provided detoxicant, as well as repeatedly washing the patient's body in order to reduce the dangerous effects of organophosphate. In addition, psychological counseling was provided to the patient and her family. With this medical treatment the patient's condition improved. She became, furthermore, actively able to express her emotions and feelings. Having a good supportive system, the patient might face problems such as poor communication with the family, by seeking resources, and learning coping skills. This case report suggests that nurses should be equipped with the professional skills to enable them to deal with a poisoned suicidal patient, and to assess the patient's support system and family structure professionally. Caregivers' continuous assistance to the patient, moreover, is a significant element in the patient's rehabilitation.