一位急性心肌梗塞合併心因性休克病人之照護經驗

Nursing Care Experience of a Patient with Acute Myocardial Infarction and Cardiogenic Shock

本文描述一位83歲女性，因急性心肌梗塞合併心因性休克病人之加護經驗。個案因面臨病情惡化而入住加護病房，期間因使用主動脈內氣球幫浦等維生儀器，引起其內心極大的衝擊，使得個案產生不安、焦慮等情緒，筆者於2022年2月20日至2022年3月10日護理期間，運用Gordon十一項健康功能型態做為評估架構，透過身體評估、會談、觀察及傾聽等方式收集資料及進行整體性評估，在照護過程中發現個案有心輸出量減少、無效性呼吸型態、焦慮等健康問題。藉由個別性、獨特性之護理，包括：（1）運用按壓、肢體運動等漸進活動組合式照護、改善組織灌流改變問題（2）透過跨團隊照護模式避免疾病合併症產生（3）建立信任的護病關係，透過按摩等肢體接觸減輕個案焦慮情緒，並建議返家後持續復健、搭配心肺復健運動日誌、定期監測與追蹤；期望藉由此照護經驗，能提供照護人員相關照護之參考，進而提升照護品質。

This article describes the intensive care experience of an 83-year-old female patient diagnosed with acute myocardial infarction complicated by cardiogenic shock. Due to the worsening of her condition, the patient was admitted to the intensive care unit (ICU), where she was supported by life-sustaining devices, including an intra-aortic balloon pump (IABP). The use of such equipment caused significant emotional distress, leading to feelings of unease and anxiety. During the nursing care period from February 20 to March 10, 2022, the author used Gordon’s Eleven Functional Health Patterns as the assessment framework. Through physical assessment, interviews, observation, and active listening, comprehensive data were collected to evaluate the patient holistically. The main health problems identified included decreased cardiac output, ineffective breathing pattern, and anxiety.
Individualized and personalized nursing care strategies were implemented, including:(1) A progressive combination of care involving massage and limb exercises to improve tissue perfusion,(2) Prevention of disease complications through an interdisciplinary care model, and(3) Establishing a trusting nurse-patient relationship, using therapeutic touch such as massage to alleviate the patient's anxiety.
In addition, the patient was advised to continue rehabilitation after discharge, with the use of a cardiopulmonary rehabilitation exercise log and regular monitoring and follow-up. It is hoped that this care experience can serve as a reference for healthcare professionals and contribute to improving the quality of care.