照顧一位產後出血併發肺水腫患者之護理經驗

The Nursing Experience for a Postpartum Hemorrhage Patient Complicated with Pulmonary Edema

本文旨在描述一位產後出血併發肺水腫之護理經驗。護理期間自2017年02月28日至2017年03月03日。在照護期間以Gordon十一項功能性健康型態為評估工具，發現個案因產後出血在短時間內輸注大量的體液引發肺水腫，而出現「體液容積過量」之護理問題，在產後期因子宮收縮及會陰傷口，而出現「急性疼痛」之護理問題，也因為新生兒被診斷十二指腸閉鎖不全必需接受手術，以及擔心奶水不足，而出現「焦慮」之護理問題。於照護期間，筆者協助個案採半坐臥式及提供適當的氧流量，以維持足夠的氧合；並且教導限鹽飲食原則及水分的控制，以預防體液滯留。提供緩解疼痛之方法，如冰敷、溫水坐浴、協助及教導子宮按摩及止痛劑使用。與個案建立良好的護病關係及鼓勵其說出心中的感受，並且提供有關新生兒疾病之相關資訊及教導促進乳汁分泌的方法，以減輕其焦慮。盼藉此護理經驗能提供護理人員作為日後照顧類似病人之參考。 This case report described the nursing experience for a postpartum hemorrhage patient complicated with pulmonary edema. The nursing period was from February 28 to March 3, 2017, according to the data analyzed by the assessment tool of Gordon’s 11 functional health patterns, the result indicated that the patient’s nursing problem including ＂excess fluid volume＂, due to postpartum hemorrhage complicated with pulmonary edema, caused excess of fluid infusion, ＂acute pain＂ due to uterine contractions and perineal wound, and ＂anxiety＂ because of neonatal diagnosed with duodenal atresia required surgery and worry about lack of breast milk. During the period of caring, the author assisted the patient with semi- Fowler's position and providing proper oxygen flow to maintain adequate oxygenation, and taught low salt diet and water control to prevent body fluid retention. Providing the patient’s pain relief methods, such as ice packs, sitz bath, taught uterine massage and use analgesics. Reducing the patient's anxiety by encouraging the patient to speak feelings, and provide information on neonatal disease and taught ways to promote breast milk secretion. The findings are helpful to serve a reference to other nurses care of similar postpartum hemorrhage complicated pulmonary edema patient.

This case report described the nursing experience for a postpartum hemorrhage patient complicated with pulmonary edema. The nursing period was from February 28 to March 3, 2017, according to the data analyzed by the assessment tool of Gordon’s 11 functional health patterns, the result indicated that the patient’s nursing problem including ＂excess fluid volume＂, due to postpartum hemorrhage complicated with pulmonary edema, caused excess of fluid infusion, ＂acute pain＂ due to uterine contractions and perineal wound, and ＂anxiety＂ because of neonatal diagnosed with duodenal atresia required surgery and worry about lack of breast milk. During the period of caring, the author assisted the patient with semi- Fowler's position and providing proper oxygen flow to maintain adequate oxygenation, and taught low salt diet and water control to prevent body fluid retention. Providing the patient’s pain relief methods, such as ice packs, sitz bath, taught uterine massage and use analgesics. Reducing the patient's anxiety by encouraging the patient to speak feelings, and provide information on neonatal disease and taught ways to promote breast milk secretion. The findings are helpful to serve a reference to other nurses care of similar postpartum hemorrhage complicated pulmonary edema patient.