% 1 4 intermediate syndrome, IS; John, Oommen, & Zachariah, 2003 AChE John et al., 2003; Peter et al., 2006 二有機磷對身體器官現存

Size: px

Start display at page:

Download "105 200060% 1 4 intermediate syndrome, IS; John, Oommen, & Zachariah, 2003 AChE 2004 2004 John et al., 2003; Peter et al., 2006 二有機磷對身體器官現存"

锵汲
7 years ago
Views:

1 104 照護一位有機磷自殺婦女病患之護理經驗林慧雯周繡玲 * 有機磷中毒在目前有日益增多的趨勢, 中毒機轉影響個案病情相當迅速, 且易因延遲送醫而引發中毒症狀危急生命, 故具備豐富急救知識及敏銳判斷力對於照顧此類病患是非常重要本篇報告是描述照顧一位服用有機磷自殺的個案, 藉由直接護理觀察及溝通等方式收集相關資料, 確立個案有有機磷中毒之現存性損傷個人因應能力失調等主要問題個案住加護病房急性期間除維持呼吸道通暢及循環正常外, 特別關注個案解毒劑使用後反應及反覆身體沖洗, 來降低有機磷毒物對身體功能傷害的影響 ; 再藉由關懷與個案及家屬建立良好的護病關係, 以陪伴傾聽方式, 鼓勵個案主動表達心中情緒感受, 建立良好的支持系統, 使得個案在日後面對與家人溝通不良等壓力事件時, 能主動尋求資源, 學習以正向因應技巧面對問題期望透過此個案護理經驗的分享, 能提升護理人員對有機磷中毒處理應變能力, 並加強對於家庭支持系統結構之專業評估, 持續追蹤病患疾病進展, 協助病患獲得身心靈之康復, 重新恢復正常生活有機磷中毒自殺婦女加護病房前言 organophosphate poisoning, OPP Peter, Moran, & Graham, 2006 * 文獻查證一有機磷中毒之症狀與機轉 Melum & Kearney, 2001 acetylcholinesterase, AChE mole/sec/ml 20 40%

外, 特別關注個案解毒劑使用後反應及反覆身體沖洗, 來降低有機磷毒物對身體功能傷害的影響 ; 再藉由關懷與個案及家屬建立良好的護病關係, 以陪伴傾聽方式, 鼓勵個案主動表達心中情緒感受, 建立良好的支持系統, 使得個案在日

2 % 1 4 intermediate syndrome, IS; John, Oommen, & Zachariah, 2003 AChE John et al., 2003; Peter et al., 2006 二有機磷對身體器官現存性損傷之處置與護理 Melum & Kearney, 2001 Atropine 2mg IV PAM Pralidoxime 1 g IV qd AChE 2000 Peter et al., mm bpm 個案簡介一基本資料 52 二發病經過 OPP /22 三自殺婦女的心理衝擊及個人因應能力 Erikson 護理評估

, 2006 二有機磷對身體器官現存性損傷之處置與護理 Melum & Kearney, 2001 Atropine 2mg IV 15 24 PAM Pralidoxime

3 106 表一運用羅式適應模式進行個案護理評估 4/15 ph 7.25 PaO mmhg PaCO mmhg HCO 3 20 mmol/l SpO %GCS E 1 V T M 1 ICUA/C mode FiO 2 60pH PaO mmhg PaCO 2 28 mmhg HCO mmol/l SpO % /50 mmhg25 30 / Atropine 2 mg IV PAM 250mg 96h IV NaHCO 3 3 amp IV 4/16 GCS E 2 V T M 4 Atropine 2 mg IV PAM 250mg 96h IV A/C mode FiO 2 40 SpO 2 98% CXR Hgb 12 gm/dl WBC: cumm AChE 26% 150 cc/4 1 2 mmhgn/s 2000 cc IV 4/17 E 4 V T M A/C SIMV Pressure Support mode FiO 2 40% SpO 2 98%GCS E 1 V T M 2 1.0Atropine 2 mg IV 4/18 GCS E 4 V T M 6 SIMV Pressure Support mode FiO 2 40% SpO 2 98% CXR O 2 6 L/min 4/21 GCS E 4 V 5 M 6 2 L/min SpO 都 52 歲是中年人了, 我的身材應該算中等吧! 現在我的身體這個樣子, 還要家人幫忙, 如果這次我身體好不了, 家裡誰能照顧我? 兒子又該怎麼辦?4/ / /15 那天吵架我真的沒責怪她的意思, 只是我兒子精神有一點問題, 擔心他沒人照顧 ; 如果不在意她, 也不會來醫院看她 4/18 我個性本來就內向不多話, 和家人比較沒什麼話講, 工作辭職後, 在家照顧兒子, 他精神方面有問題已經五六年了, 我也不知道小孩子怎會生這種病? 吃藥控制時好時壞, 他有時發病起來連自己都會害怕! 有時候我心情煩, 就會去廟裡拜拜唸唸佛經, 每次到廟裡去都覺得心裡很平靜我先生工作忙只是叫我要好好照顧孩子, 很少幫忙, 他只要發現兒子在家中吵鬧, 就指責我沒有照顧家裡及兒子, 我也只能嘴巴閉起來, 什麼都別說那天我才從廟裡回家, 先生又指責我沒照顧小孩跑出去, 還說乾脆離婚好了! 就可以長住在廟裡你知道嗎? 照顧兒子都只靠我, 沒人幫忙! 連出去走走都被責怪我覺得很委屈, 乾脆死了算了! 52 5 至於女兒在台北工作, 平時也不住在家裡, 雖然會打電話回來問候, 不想讓她擔心, 也不會向她說太多

1% 50 70 90/50 mmhg25 30 / Atropine 2 mg IV PAM 250mg 96h IV NaHCO 3 3 amp IV 4/16 GCS E 2 V T M 4 Atropine 2 mg IV PAM 250mg 96h IV A/C mode FiO 2 40 SpO 2 98% CXR Hgb 12 gm/dl WBC:10100 16300 cumm

4 107 護理過程一現存性損傷 / 有機磷中毒影響主要器官產生中毒現象 S1 4/15 小姐, 我媽喝農藥自殺現在情況不知道怎麼了? S2 4/15 小姐, 我太太怎麼流這麼多口水? S3 4/16 小姐, 我媽她會醒嗎? 後續會做什麼處理, 有後遺症嗎? O1 4/15 E 1 V T M 1, Pupil size L/R: 1.0/1.0, Light reflex(-), HR: 50, ph: 7.25, PaO 2 : 56.5 mmhg, PaCO 2 : 40.1 mmhg, SpO 2 : 90.1% O2 4/15 4/ O3 4/15 ICU A/C mode, FiO 2 : 60 ABG data: ph: 7.283, PaO 2 : 98.5 mmhg, PaCO 2 : 28 mmhg, SpO 2 : 96.1% O4 4/ /50 mmhg O5 4/17 SIMV+PS16mode FiO 2 : 40% SpO 2 : 98% CXR O6 4/15 Atropine 2 mg IV PAM 250 mg IV q6h 24 O7 4/16 AChE: 26 4/18 評估性措施 : bpm 4 mm AChE 60% SpO 2 95%ABG AChE 護理性措施 : X-ray %O 治療性措施 : 1. PAM 250 mg/ IV q6h Atropine 2 mg IV /17 00:30 GCS: E 4 V T M 6 4/17 19:30 GCS: E 1 V T M 2, Pupil size L/R:1.0/1.0, Light reflex(-) 30 /min, SIMV + PS A/C mode Atropine 2 mg IV 4/18 01: / / mm, Light reflex(+) bpm 4. 4/ /18Atropine PAM 6. 4/21 AChE 70%

1% O2 4/15 4/16 301 2 O3 4/15 ICU A/C mode, FiO 2 : 60 ABG data: ph: 7.283, PaO 2 : 98.5 mmhg, PaCO 2 : 28 mmhg, SpO 2 : 96.1% O4 4/15 50 70 90/50 mmhg 15 30 35.

5 108 二個人因應能力失調 / 缺乏明確支持系統 S1 4/15 那天吵架, 就是我兒子精神有問題, 她又跑去廟裡, 我只是說她兩句, 沒責怪她的意思 S2 4/15 心裡很在意她, 想來醫院看她, 但不知要說什麼, 她怎會這麼傻, 跑去自殺 S3 4/20 我個性本來就比較沉默, 和家人本來就比較沒話講 S4 4/20 我兒子的生活起居都是我在照顧, 吃藥控制時好時壞, 發病時連我都會害怕, 不知到會發生什麼事情 S5 4/19 我女兒在台北工作, 平時不住家裡, 偶爾會打電話回來, 但不想讓她擔心, 所以不太會向她訴苦 S6 4/19 自從兒子生病後, 就沒工作, 也不能賺錢幫家裡的忙, 常被先生嫌棄 S7 4/20 我先生罵我沒照顧小孩, 還說乾脆離婚好了! 孩子都是我在照顧, 又沒人幫忙, 我越想越委屈, 乾脆死了算了 O1 4/16 17 O2 4/17 O3 2 3 評估性措施 : 教育性措施 : 諮商性措施 : 一表達心理感受 1. 4/ / / /2 二說出調適方法 1. 4/ / /25 4.

但不想讓她擔心, 所以不太會向她訴苦 S6 4/19 自從兒子生病後, 就沒工作, 也不能賺錢幫家裡的忙, 常被先生嫌棄 S7 4/20 我先生罵我沒照顧小孩, 還說乾脆離婚好了!

6 109 結 2004 Pfaff, 1998 現在想想, 自殺不值得, 以後我會主動告訴家人自己的想法或困擾, 一起討論解決的辦法先生有體諒照顧兒子的辛苦, 現在兒子有按時吃藥, 心情控制比較好誌論謝參考文獻 / 9.XLS Orem John, M., Oommen, A., & Zachariah, A. (2003). Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome. Neurotoxicology, 24(1), Melum, M. F., & Kearney, K. (2001). Organophosphate toxicity. American Journal of Nursing, 101(5), Peter, J. V., Moran, J. L., & Graham, P. (2006). Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta-analytic techniques. Critical Care of Medicine, 34(2), Pfaff, B. L. (1998). Emergency department management of nerve agent exposure. International Journal of Trauma Nursing, 4(3),

XLS 200269 75 2002Orem 49 388 94 1999 10 229 35 2004 382 407 2001 304 22 24 2002 198 51 52 2004 12 153 63 2000 1 33 1 17 2000 1 321 13 2004 16 3142 144 2000 163 172 John, M., Oommen, A.

7 110 Nursing Care for an Organophosphate Poisoning Suicidal Woman Hui-Wen Lin Hsiu-Ling Chou * Abstract: The incidence of organophosphate poisoning (OPP) has increased rapidly recently. The poisoning affects the patient s condition quickly, and the patient s life can be endangered if there is a delay in transporting him to a place of treatment. Integral resuscitation knowledge and sensitive judgment are vital to patient care. The purpose of this investigation was to describe the treatment of a suicidal woman who had overdosed on organophosphate. Data were collected through the methods of direct patient care, observation, and communication, and problems were identified, such as risk of injury by organophosphate poisoning, and ineffective coping. During acute phases, the authors tried to keep the patient s airways clear, and respiration and circulation normal, and to maintain vital signs. Caregivers provided detoxicant, as well as repeatedly washing the patient s body in order to reduce the dangerous effects of organophosphate. In addition, psychological counseling was provided to the patient and her family. With this medical treatment the patient s condition improved. She became, furthermore, actively able to express her emotions and feelings. Having a good supportive system, the patient might face problems such as poor communication with the family, by seeking resources, and learning coping skills. This case report suggests that nurses should be equipped with the professional skills to enable them to deal with a poisoned suicidal patient, and to assess the patient s support system and family structure professionally. Caregivers continuous assistance to the patient, moreover, is a significant element in the patient s rehabilitation. Key Words: organophosphate poisoning, suicidal woman, intensive care unit. RN, Formerly Department of Nursing, Cardinal Tien Hospital; *RN, MSN, Doctoral Candidate, Graduate Institute of Clinical Medical Sciences, Chang-Gung University. Received: November 9, 2006 Revised: January 4, 2007 Accepted: July 28, 2007 Address correspondence to: Hsiu-Ling Chou, No. 23, Lane 61, Hang-Chou S. Rd., Sec. 2, Taipei 10641, Taiwan, ROC. Tel: ; yaoct@tpts5.seed.net.tw

Integral resuscitation knowledge and sensitive judgment are vital to patient care.

16

序 1 16 序 2 KK KK KK KK KK KK 溫溫 KK KK 周婉芬博士 2016 年 5 月前言平安健康便好了 16 10 ICU ICU 26 300 26 10 ICU ICU 曾錦強 2016 年 5 月目錄 Chapter 1 家庭親子關係 1.1 多存款入關係戶口 2 1.2 不傷關係管學業 12 1.5

% 1 4 intermediate syndrome, IS; John, Oommen, & Zachariah, 2003 AChE John et al., 2003; Peter et al., 2006 二 有 機 磷 對 身 體 器 官 現 存

% 1 4 intermediate syndrome, IS; John, Oommen, & Zachariah, 2003 AChE John et al., 2003; Peter et al., 2006 二有機磷對身體器官現存