一位憂鬱症患者服用巴拉刈自殺之急診護理經驗

The Emergency Nursing Care Experience of Caring a Patient with Depressive Disorder Who Committed Suicide by Taking Paraquat

本文主要在描述一位憂鬱症個案，因經濟壓力及喪偶因素，再加上家庭及社會支持系統薄弱，導致服用巴拉刈自殺之急診護理經驗，照護期間自2019年3月2日到3月4日，筆者藉由直接照護、會談、病歷查閱進行資料收集，並運用Gordon十一項健康功能型態評估，歸納出個案有危險性損傷、急性疼痛、個人因應能力失調之健康問題。個案因先生突然車禍過世頓失依靠，加上工作不順及家庭支持系統薄弱，導致情緒低落，進而服用巴拉刈自殺，併發肺、腎臟損傷，引發筆者進一步探討。急診照護期間，協助個案降低巴拉刈對人體之傷害，並採低氧療法，監測肺損傷情形，經血液透析治療，維持體液電解質平衡，協助緩解因巴拉刈造成的口腔腐蝕及口腔潰瘍之疼痛，建立互信的護病關係，協助個案表達近期喪偶的感受，轉化負向想法，讓個案能減低憂鬱情緒，預防自殺的再發生，並安排跨團隊合作，由精神科醫師及社工師會診，提供後續心理治療，早日康復回歸生活。期望藉此臨床經驗，能在進行緊急醫療處置時兼具心理問題探討與協助，建議將此列入專科性教育訓練課程，加強急診護理師，面對憂鬱症病人之溝通技巧及毒藥物中毒處置，促使急診護理照護能更趨近身心靈完善的全人照護。

This paper describes the emergency nursing care experience of a patient (case study) with depressive disorder who committed suicide by taking paraquat due to such factors as financial strains, widowhood and weak family and social support systems. The nursing care period was from March 2 to March 4, 2019. The author collected data through direct nursing care, interviews and medical record reviews. Gordon’s 11 functional health patterns were used to evaluate and summarize potentially dangerous damage, acute pain and ineffective individual coping-related health problems. The case study suddenly lost support after her husband’s death in a car accident, hindrances at work and a weak family support system, leading to lowspiritedness and eventually committing suicide by paraquat. The pulmonary and renal damage-associated complications prompted the author to further explore the case study. During the emergency care period, the case study was assisted in reducing the harm of paraquat to the body. In addition, the hypoxic therapy was administered to monitor lung damage. Through hemodialysis treatment, the body’s fluid and electrolyte balance was maintained, while assistance was given to alleviate the oral corrosion and oral ulcer pain caused by paraquat. A nurse-patient relationship of mutual trust was established, and the case study was assisted in expressing her feelings after the loss of her spouse and convert negative thoughts to reduce depressive emotions and prevent recurrence of suicide behavior. Additionally, cross-team collaboration arrangements were made, psychiatrists and social workers conducted joint consultations and subsequent follow-up psychotherapy was provided for the case study to recover and resume a normal life as soon as possible. It is expected that through this clinical experience, psychological problemrelated discussions and assistance be conjunctively carried out during emergency medical disposal. It is also suggested that they be included in specialized educational training courses to strengthen the nurses’communication skills and pesticide poisoning disposal when faced with patients with depressive disorder, so that emergency nursing care can be more in line with holistic care that perfects the body, mind, and soul.