照護一位熱中暑個案接受低?療法之護理經驗

Caring for A Heatstroke Case Undergoing Hypothermia Therapy: A Nursing Experience

本文主要探討一位70歲自耕田農夫到田裡耕作，按照往常經驗無任何防護裝備，在高溫炎熱氣候下長時間工作，以致初次發生熱中暑合併低血容性休克，個案意識昏迷無法自主呼吸，有高燒、昏迷症狀陷入病危狀態，藉由低溫療法介入降低熱傷害所產生的後遺症，個案甦醒後面對身上莫名管路、陌生醫療環境，承受極大身心壓力。護理期間自2021年7月5日至7月14日，運用Gordon十一項健康功能評估，以直接照護、身體評估、會談及查閱病歷紀錄等方式收集資料，確立個案有體溫過高、氣體交換障礙及面對陌生環境產生焦慮、知識缺失等健康問題。照護期間，運用醫療團隊共同照護，積極降溫預防多重器官衰竭併發症、降低死亡率，並盡早開始呼吸器脫離訓練，鼓勵及引導個案表達心中的感受及擔心害怕事情，並適時運用支持放鬆療法及增加家屬陪伴和鼓勵，配合呼吸訓練，幫助個案的夜眠獲得改善，最後成功脫離呼吸器。期望此次護理經驗，能提供臨床護理人員照護之參考，並建議各地區可定期做社區據點訪視做相關衛教，以增加民眾中暑觀念的認知。

The article mainly discusses a 70-year-old farmer who works in the field without any protective equipment during prolonged hours in hot weather, leading to heatstroke with hypovolemic shock for the first time. The case presented symptoms of high fever, coma, and critical condition. Intervention with hypothermia therapy was implemented to reduce the sequelae of heat injury. The patient regained consciousness but faced stress from the unfamiliar medical environment and equipment. The nursing care period was from July 5, 2021, to July 14, 2021. Using Gordon's Functional Health Patterns assessment, data was collected through direct care, physical assessments, discussions, and medical record reviews, identifying issues of elevated body temperature, gas exchange impairment, anxiety due to unfamiliar surroundings, and lack of knowledge. During the care period, a multidisciplinary medical team was involved in actively cooling the patient to prevent multiple organ failure and reduce mortality. Early initiation of weaning from the respirator was encouraged, and emotional support, relaxation therapy, family presence, breathing exercises, and improved sleep were provided. The patient was successfully weaned off the ventilator. This nursing experience aims to serve as a reference for clinical care providers and suggests regular community visits for health education to increase public awareness of heat-related conditions.