照護一位心臟衰竭患者之護理經驗

The Nursing Experience of a Patient with Heart Failure

本文描述一位因疾病控制不佳致下肢水腫、呼吸喘反覆入院的心衰竭患者，因是漸進式不可逆的疾病，使個案對生活感到無力而產生焦慮之護理經驗。筆者於2019/8/7至8/21護理期間藉由觀察、身體評估、會談與傾聽蒐集生理、心理與靈性資料，確立個案有活動無耐力、體液容積過量、焦慮等健康問題。護理過程中運用Watson關懷照護理論給予相關護理措施，包括:與個案建立良好的治療性關係，密切監測體液及體重變化，教導適當限制水份及鹽份攝取重點，降低心臟負荷；針對活動無耐力教導及執行心臟復健運動，改善肌肉無力；以傾聽、關懷、陪伴，協助個案理解及接受疾病進展，並以心臟衰竭護理指導單張協助個案增加自我照顧的知識及注意事項，個案於出院前呼吸喘及下肢水腫得以改善，能正向接受心臟復健運動，遵從日常限水、限鹽的飲食攝取，最終個案自我照顧行為能力提升，減輕對疾病的焦慮感。心臟衰竭患者居家照護的重點是每天量體重，因控制體重及水分能減少心臟負荷，建議醫院遠距健康管理中心能引進傳輸型體重機，以合理的費用提供此類病人租借並鼓勵加入遠距服務，以利醫療團隊確實掌握病人是否落實自我管理，控制疾病、進而降低再入院率。

This article describes the nursing experience of a patient with heart failure who was repeatedly admitted to the hospital with lower extremity edema and wheezing due to poor disease control. Because it is a progressive and irreversible , the patient feels weak in life and causes anxiety. The author collected physiological, psychological, and spiritual information through observation, physical assessment, interviews and listening during the nursing period from August 7 to 21, 2019, and confirmed that the case has health problems such as impatience, excessive body fluid volume, and anxiety. The Watson’s caring and nursing theory is used to provide relevant nursing measures, including: establishing a good therapeutic relationship with the case, closely monitoring body fluids and weight changes, teaching appropriate restrictions on water and salt intake, and reducing heart load; Teach and perform cardiac rehabilitation exercises to improve muscle weakness; accompany the case to help understand and accept the progress of the disease, and use the heart failure care guide leaflet to help increase the knowledge and precautions of self-care. The patient’s breathing and lower extremity edema were improved before discharge, and he was able to receive cardiac rehabilitation exercises. He followed a daily diet with limited water and salt. Eventually, the patient’s self-care behavior was improved and his anxiety was reduced. The focus of home care for patients with heart failure is to measure their body weight every day. Since controlling body weight and water can reduce the heart load, it is recommended that the health management center introduce a transmission type weight machine to provide such patients with rent at a reasonable cost and encourage participation in remote Services, so that the medical team can really grasp whether the patient implements self-management, control the disease, and then reduce the readmission rate.