照顧一位急性失代償性心衰竭合併無望感個案的護理經驗

Nursing Experience in an Acute Decompensated Heart Failure Patient with Hopelessness

本文敘述照顧一位因冠狀動脈鈣化導致急性失代償性心衰竭之重症個案。病人接受主動脈內氣球幫浦、連續性靜脈對靜脈血液過濾術及接受心臟移植之護理經驗。2018年3月21日至2018年4月18日護理期間透過觀察、身體評估、會談及病歷審查，歸納個案健康問題有心輸出量減少、活動無耐力、無望感。護理措施包含維持個案足夠的心輸出量，減低心肌耗氧，指導個案進行床上復健運動，增加活動耐受力。運用觀察、傾聽、關懷與個案建立治療性人際關係，同理個案對疾病預後產生無望感的身心問題。透過醫療團隊支持，讓個案願意分享心情，保有希望，討論及接受治療計畫。最後，個案成功配對並接受心臟移植，生理不適症狀獲得改善，使個案對疾病進展及護理具有信心，重燃生活的希望。建議心臟內科加護病房護理師強化急性失代償性心衰竭周全性與連續性照護的能力，提升病人的照護品質。希冀藉此照護經驗之分享，作為急性失代償性心衰竭病人照護之參考依據。

This article describes caring for a critically ill patient with acute decompensated heart failure due to coronary artery calcification. The patient received the treatment of intra-aortic balloon pump, continuous veno-venous hemofiltration and heart transplantation. During the nursing period from March 21, 2018 to April 18, 2018, through observation, physical assessment, interviews and medical record review, the nurse summarized the health problems including decreased cardiac output, activity intolerance and hopeless. The nursing intervention include maintaining the patient's adequate cardiac output, reducing myocardial oxygen consumption, guiding the patient to perform bedside rehabilitation exercises, and increasing activity tolerance. Use observation, listening, and care to establish therapeutic interpersonal relationships with the case and empathized patient's hopelessness. With the support of the medical team, patients are willing to share their feelings, keep hope, discuss and accept treatment plans. Finally, the case was successfully matched and received a heart transplant, and the symptoms of physical discomfort were improved, which enabled the case to have confidence in the disease and care, and the hope of life was made. It is recommended that nurses strengthen their ability about acute decompensated heart failure and help patients and their families. It is hoped that the sharing of nursing experience will serve as a reference for the care of patients with acute decompensated heart failure.