急性心肌梗塞合併肺水腫患者之護理經驗

Nursing Experience of a Patient with First Time Acute Myocardial Infarction Attack and Pulmonary Edema

本文是探討一位急性心肌梗塞合併肺水腫患者的護理經驗，該患者於接受緊急冠狀動脈擴張術後入加護病房，接受各種藥物及侵入性之治療；為減少心肌組織再度受損，並達到心肌氧氣供應及氧氣需求之間的最佳平衡，個案必須絕對臥床休息；此外，病患尚須面對疾病突發帶來的心理衝擊、對疾病的認知度不足與活動受限制等問題。護理期間為年月日至月日，運用十一項健康功能型態評估及觀察、會談、傾聽等方式收集與分析資料，應用護理診斷確認個案有心肺組織灌流失效、焦慮及知識缺失等問題。一方面嚴密監測生命徵象，提供生理照護，預防心律不整、心因性休克、肺水腫及心臟衰竭等合併症發生；另一方面則運用護理措施及家屬之支持與關懷，處理個案住院期間的身心問題，如：焦慮及壓力的調適等；使個案病情能獲得控制順利轉出加護病房。

This article describes the nursing experience of a patient who experienced a firstattack of acute myocardial infarction complicated with pulmonary edema. Thepatient received percutaneous transluminal coronary angioplasty (PTCA) immediately,and was then sent to the intensive care unit (ICU) for further treatment. In order toreduce the oxygen demand of heart tissue and hypoxic damage to the cardiac muscle,the patient needed absolute bed rest. During the caring period, from April 15, 2004to April 20, 2004, we collected information through clinical observation and interviews.According to the eleven criteria of Gordon and Nursing diagnosis, the patient hadineffective tissue perfusion, anxiety and knowledge deficit. Therefore, we observedthe patient's vital signs carefully and provided physiologic care to prevent complicationssuch as arrhythmia, cardiogenic shock, pulmonary edema and heart failure. Moreover,we properly utilized nursing intervention and support from family members to dealwith the patient's psychologic and physiological problems. The patient recoveredwell and was later transferred to a ward smoothly.