一位慢性血栓栓塞性肺高壓併右心衰竭病人之照護經驗

The Nursing Experience of Caring a Patient with Chronic Thromboembolic Pulmonary Hypertension and Right Heart Failure

本文描述一位67歲女性，因患有慢性血栓栓塞性肺高壓併右心衰竭而入院治療，住院期間初次面臨侵入性心導管檢查，由於不了解檢查及後續相關治療利與弊，進而出現疑惑、惶恐、焦慮及不安情緒。因此，為了協助個案減輕焦慮，增加對疾病瞭解，召開家庭會議，尊重病人的醫療決策，並教導自我照護之方法。護理期間於2019年08月04日至2019年08月17，筆者藉由會談、觀察與查閱病歷收集資料，運用生理、心理、社會、靈性四大層面進行整體性評估，歸納出三項健康問題為：心輸出量減少、焦慮、健康尋求行為有關。照護措施包含：幫助個案了解心導管檢查之目的與風險，提供心導管檢查與藥物之衛教單張，且教導肺高壓的注意事項與飲食攝取原則，順利緩解個案的惶恐、焦慮與不安，同意接受心導管介入治療，並已正向態度面對疾病與後續照護問題。希望藉此次照護經驗，能分享且提供給臨床護理人員做為參考，並對此類病人有更深入的了解，進而提供適切的護理。

This case report presents the nursing care of a 67-year-old female patient admitted for the treatment of chronic thromboembolic pulmonary hypertension complicated by right heart failure. During hospitalization, the patient faced an invasive diagnostic procedure—cardiac catheterization—but initially lacked a clear understanding of its risks, benefits, and subsequent treatment implications. Consequently, she experienced significant apprehension, fear, anxiety, and restlessness. To address these concerns, a family conference was organized to reduce anxiety, enhance disease-related knowledge, respect the patient’s autonomy in medical decision-making, and provide education on self-care strategies. The nursing care period extended from August 4 to August 17, 2019. Data were collected through patient interviews, observation, review of medical records, and comprehensive assessment based on four dimensions—physical, psychological, social, and spiritual. Three primary nursing problems were identified: decreased cardiac output, anxiety, and health-seeking behavior. Nursing interventions included explaining the purpose and potential risks of cardiac catheterization, providing educational materials about the procedure and related medications, and offering guidance on dietary principles and precautions for pulmonary hypertension. These interventions effectively alleviated the patient’s anxiety and enhanced her understanding and confidence. Ultimately, the patient consented to undergo interventional cardiac catheterization, adopted a more positive attitude toward her condition, and actively participated in her care plan. This case highlights the importance of patient-centered nursing interventions and effective communication in reducing anxiety and promoting informed decisionmaking among patients facing invasive cardiac procedures. By sharing this clinical experience, nurses can deepen their understanding of the psychosocial needs of patients with pulmonary hypertension and improve the quality and continuity of care in similar cases.