照顧一位主動脈剝離術後因心衰竭產生無望感之護理經驗

A Nursing Experience in Caring for a Postoperative Aortic Dissection Patient Experiencing Hopelessness Related to Heart Failure

本文描述一位54歲男性因突發胸痛診斷為A型主動脈剝離，緊急接受主動脈弓置換術並置放支架，術後因併發心臟衰竭產生無望感之護理經驗。筆者於2024年4月2日至5月2日，運用Gordon十一項功能性健康型態進行評估，確立個案有心輸出量減少、活動無耐力及無望感等健康問題。於照護過程主動提供主動脈剝離術後及心臟衰竭衛教資訊，與團隊共同訂定心肺復健計畫，邀請家屬一同學習並加入其中，減少疾病惡化和併發症，進而緩解個案心輸出量減少及增加活動度，激發自我參與心肺復健計畫意願及掌握自我管理技巧，建立健康生活習慣，並轉介至生活型態醫學門診，為減少返家後獨自面對疾病之挑戰，強化自我管理行為，以達全面性照護。建議院方可增加生活型態醫學門診之個管師及醫療資訊人員，以利提供相關聯繫管道，讓個案返家面臨醫療監測儀器有狀況時能進行適時調整，以利實現更全面且持續性的照護目標。

This article presents a nursing experience of caring for a 54-year-old male diagnosed with acute type A aortic dissection who underwent emergent total arch replacement with stent implantation and subsequently developed heart failure accompanied by hopelessness. From April 2 to May 2, 2024, Gordon's eleven functional health patterns were applied for comprehensive assessment. The major nursing problems identified were decreased cardiac output, activity intolerance, and hopelessness.
Individualized education regarding postoperative aortic dissection and heart failure management was provided. A multidisciplinary cardiac rehabilitation program was implemented, and family members were encouraged to participate to enhance support and adherence. Interventions focused on symptom monitoring, flu id and activity management, rehabilitation training, and strengthening self-care abilities to prevent deterioration and complications. The patient gradually improved in physical endurance, demonstrated increased engagement in rehabilitation, and developed greater confidence in self-management.
To ensure continuity of care, the patient was referred to a lifestyle medicine clinic after discharge. It is recommended that healthcare institutions strengthen staffing of case managers and medical information personnel to support home-based monitoring and timely adjustment of medical devices, thereby promoting comprehensive and continuous care.