照護一位經產婦產後出血之加護經驗

The Intensive Nursing Care Experience of Caring a Multipara with Postpartum Hemorrhage

本文探討一位40歲經產婦於產後子宮收縮不良導致產後出血，經輸液治療後發生肺水腫而插管轉入加護病房，面對與孩子分離，個案擔心無法完成母性角色而感到焦慮不安，護理期間為2016年12月18至12月28日，運用Gordon十一項功能性健康型態做為評估工具，經由身體評估、直接觀察、病歷調閱、個案使用手勢、唇語溝通及與案夫會談收集資料加以分析，確立個案主要問題有：體液容積缺失、焦慮及親職角色衝突，筆者以家庭為中心的照護方式，主動關懷個案，鼓勵以書寫或手勢表達對先生及孩子的關心，適時開放彈性會客，減緩焦慮感|利用通訊軟體視訊了解孩子現況、手機網路購物挑選嬰兒衣物等方式，增強個案的母性角色，並藉由跨領域團隊會議的討論，提供適切的身、心、靈照護，期能將此經驗分享給護理同仁作為臨床實務經驗之交流。

This article described the nursing experience of caring a 40-year-old mother with postpartum uterine contractions resulting in postpartum hemorrhage, and then pulmonary edema after infusion treatment. The patient was transferred to an intensive care unit. Due to separation with her newborn baby, the mother was worried about failing to play the role as a mother and thus felt anxious. During the care period from December 18 to 28, 2016, using Gordon's ten functional health patterns as assessment tools, through physical assessment, direct observation, medical history review, gestures expression, lips communication, and meeting with the husband, data were collected and further analyzed. The mother's main problems were identified as the following: loss of body fluid volume, anxiety, and parental role conflict. The author took a family-centered care approach, actively offered additional care, and encouraged the patient write down or use gestures to express her concerns about her husband and baby. Also, flexible schedule was offered for meeting visitors to alleviate anxiety. Other approached include encouraging the patient to use communication software to learn about baby's updated, and shop for baby clothes via online shopping tool to enhance the feeling of maternal role. Finally, through multidisciplinary team meetings and discussions, overall physical and mental care were provided. This clinical practical experience can be shared with nursing colleagues for future references.