照護一位肥厚性心肌症猝死病人之加護經驗

Nursing Experience of Caring for a Patient with Sudden Death of Hypertrophic Cardiomyopathy in the Intensive Care Unit

本文描述一位二十歲男性因肥厚性心肌症引發猝死，經急救恢復心律且治療後身心無障礙，順利出院之護理經驗。護理期間為2019年7月9日至2019年7月15日，運用Gordon十一項健康功能評估，確立有心肌功能異常、呼吸道清除功能失效及焦慮等健康問題。護理期間入院後立即介入目標體溫管理，降低個案腦部損傷，並植入心臟去顫器預防心室頻脈再復發；個案因深度鎮靜造成咳嗽反射及吞嚥減弱，故加強口腔護理、翻身前抽吸口水；此外個案經歷猝死後害怕及擔心與母親之分離，加上不了解心臟去顫器的功能而焦慮，予延長案母之會客時間，運用淺顯易懂的詞彙衛教裝置體內心臟去顫器之目的，並鼓勵禱告降低心中焦慮。最後個案轉出至普通病房順利出院並回歸社會。

This case report presents the intensive care experience of a 20-year-old man, who suffered a sudden cardiac arrest after being diagnosed with hypertrophic cardiomyopathy. He underwent emergency treatment to restore his heart rate and was discharged from the hospital after successful treatment. Data were collected from July 9–15, 2019, through physical assessment, direct care provision, observations, interviews, and review of medical records. Gordon's 11 functional health patterns were used to evaluate the prevalence of health problems. Three major problems were identified in the patient: abnormal myocardial function, failure of respiratory tract clearance, and anxiety. Target temperature management was performed to reduce brain damage. Additionally, a defibrillator was implanted to prevent recurrence of ventricular tachycardia. Oral care can be strengthened and suction before change position during intubation. Furthermore, the patient experienced fear of separation from his mother and suffered a sudden cardiac arrest, which was coupled with anxiety, owing to lack of knowledge about the defibrillator and its functioning. Therefore, basic and comprehensible vocabulary was used to explain the purpose of the cardiac defibrillator, while the family visiting time was extended to reduce the patient's anxiety. The patient was gradually transferred to the general ward, and subsequently discharged from the hospital and returned to society.