照顧一位行經導管主動脈瓣膜植入術後合併肺栓塞患者的加護經驗

The Intensive Nursing Experience of Caring for a Patient with Pulmonary Embolism after Transcatheter Aortic Valve Implantation

本篇描述一位83歲接受經導管主動脈瓣膜植入術，手術後發生肺栓塞置放葉克膜老年患者之護理照護經驗，護理期間由2023年2月19日至2023年3月20日，運用身體檢查評估、會談、觀察及病歷查閱等方式收集資料，並使用Gordon十一項進行整體性評估，確認個案的健康問題為組織灌流失效：心肺、潛在危險性傷害與無望感。藉由執行個別性照護計畫：監測血液動力學及動脈氣體分析變化並提供抗凝血藥物、升壓劑、葉克膜及呼吸機支持照護，維持足夠的血液灌流及通氣，另提供家屬相關衛教，如彈性襪及下肢被動活動預防肺栓塞再次復發；密切監測出血徵象並落實無菌技術照護侵入性導管及給予家屬肺栓塞及主動脈瓣膜植入術相關的指導，預防出血及感染等潛在危險傷害併發症；另外，運用關懷與同理主動關心個案，建立良好治療性關係，引導家屬一同參與照護，鼓勵個案表達內心想法及參與照護活動，增強對疾病的控制感，以減輕個案情緒低落、逃避眼神等負向情緒表達，增強與疾病共處的信心，使個案身心靈皆能獲得完整的照護。期望藉此個案照護經驗之分享，作為未來臨床照護之參考。

This article describes the nursing care of an 83-year-old patient who developed pulmonary embolism following transcatheter aortic valve implantation, with care provided from February 19 to March 20, 2023. The author conducted a comprehensive assessment using physical examination, conversation, observation, chart review, and Gordon’s Eleven Functional Health Patterns. Identified nursing problems included ineffective tissue perfusion (heart and lungs), risk for injury, and hopelessness. An individualized nursing plan was developed, involving close monitoring of hemodynamics and arterial blood gases, administration of anticoagulants, vasopressors, and ventilator support to maintain adequate perfusion and ventilation. The author also educated the patient’s family on disease-related care, such as the use of elastic stockings and passive lower limb exercises to prevent embolism recurrence. To minimize risks of bleeding and infection, the nurse carefully observed for bleeding signs, maintained invasive catheters with aseptic technique, and provided anticoagulation information to family members. Additionally, mental support was offered to build a trusting nurse-patient relationship, while encouraging active participation from both patient and family, fostering emotional expression and improving the patient’s sense of control. These interventions reduced depressive behaviors and increased confidence in managing the illness, resulting in comprehensive physical and psychological care. The author hopes this experience serves as a reference for nursing elderly patients in similar clinical situations.