一位巴特氏症候群個案引發心室纖維顫動之急診護理經驗

Nursing Experience on a Patient of Bartter Syndrome Complicated with Ventricular Fibrillation.

本文旨在探討一位33歲女性巴特氏症候群個案因服藥不遵從導致急性低血鉀重複入院，引發心室纖維顫動（Ventricular fibrillation, VF）之急診護理經驗。照護期間為2013年5月15日下午17時23分至晚上23時55分，筆者運用Gordon十一項健康功能型態進行評估，以觀察、直接照護、溝通、會談、身體評估等方式收集個案資料，確立個案有心輸出量減少、不遵從行為及焦慮護理問題。護理過程中，筆者針對個案護理問題提供個別性護理措施，運用行動裝置協助個案增強對疾病的認知及健康管理，以增加其遵從性。給予去顫術使個案恢復穩定生命徵象，並利用傾聽及鼓勵表達感受等方式，有效緩和個案情緒及給予心理支持，使個案克服瀕死的不安與焦慮。巴特氏症候群個案為罕見疾病，此次緊急處置及臨床照護經驗具有參考價值。期盼藉此護理經驗分享有助於急診護理人員獲取相關知識，並有效運用於急診臨床照護及處置，以提升急診照護品質。

We described a nursing experience of resuscitation on a 33-year-old woman with a history of Bartter syndrome.Due to irregular medication, she presented to our emergency department with impression of hypokalemia inducedventricular fibrillation. Resuscitation with defibrillation and cardiopulmonary resuscitation were performed. Thenursing duration was between 17:23 and 23:55 on 15 May, 2013. The patient was evaluated by 11 Functional HealthPattern, including observation, direct nursing care, communication, conversation, and physical examination. After that,nursing problems including decreased cardiac output, against medical advice and anxiety disorder were found out. Theclinical nursing focused on the patient problems. The author used mobile device to enhance her perception of thedisease and health care in order to improve agreement on the medical decision-making. Successful defibrillation wasperformed and the patient returned spontaneous circulation. After that, the author listened to patient's experience andencouraged her to express. Then, the author provided emotion support to relieved patient's anxiety on the death. Barttersyndrome is a rare disease. This experience of resuscitation and clinical nursing is valuable to us. We hope thatemergency nurses can enhance their medical knowledge through this case report in order to upgrade the nursing practicein the emergency department.