運用改良伐氏操作協助一位心室上心搏過速青少年改善症狀校園護理經驗

The School Nursing Experience: Using Modified Valsalva Maneuver to Improve Symptoms in an Adolescent with Supraventricular Tachycardia

目的：本文描述一位心室上心搏過速青少年且意識清楚、血壓正常於校園期間護理經驗。方法：於2022年8月30日至2024年3月30日護理期間，運用Gordon十一項功能性健康型態為架構，以直接照護、評估、觀察、紀錄、與導師及家長溝通聯繫，確定個案有心輸出量減少與急性疼痛等健康問題。針對問題，運用生理監視器持續監測心電圖、血壓、血氧皆為穩定狀態，採用改良伐氏操作法（Modified Valsalva maneuver），協助個案面對心搏過速恢復正常之過程。結果：原心律170 - 200次/分鐘、血壓與血氧正常，使用改良伐氏操作法，經過數次動作後呈現階梯式恢復正常心律，也改善疼痛症狀。結論：學校護理師需具有高度敏銳觀察力與辨識疾病症狀，應用實證醫學與急救技術於護理措施，提供有效照護。建議：1、事件發生前調查過去病史與詳實記錄現況。2、無休克之心搏過速，可採用改良伐氏操作法改善心律，並監測心律、血壓、血氧。3、校園內所有成員應每年接受急救知識與技能訓練。

Objective: This is a case study of the school nursing process for an adolescent with supraventricular tachycardia, clear consciousness, and normal blood pressure. Methods: During the nursing care period from August 30, 2022, to March 30, 2024, the author provided hands-on care, conducted physical assessments, made observations, and maintained records, while also communicating with both tutors and the individual. Gordon's 11 Functional Health Patterns were instrumental in establishing the patient's health status. The primary nursing diagnoses for the case included decreased cardiac output and acute pain, and the electrocardiogram, blood pressure, and oximeter were continuously monitored by a physiological monitor to stabilize the state. Modified Valsalva Maneuver is used to help patients cope with the normal process of tachycardia. Results: The heart rate ranged from 170 to 200 beats per minute, the blood pressure and oximeter are normal, and the Modified Valsalva maneuver is used, and after several movements, the normal heartbeat is restored stepwise.
Conclusion: School nurses need to have a high degree of keen observation and recognition of disease symptoms and apply evidence-based medicine and first-aid techniques to nursing measures to provide effective care. Suggestion: 1. Investigate the patient's medical history and document the current condition in detail prior to the incident. 2. Tachycardia without shock can be managed with Modified Valsalva Maneuver and monitored for heart rhythm, blood pressure, and blood oxygen. 3. All school staff should receive emergency first aid knowledge and training every year.