การพยาบาลผู้ป่วยที่มีภาวะหัวใจล้มเหลวที่ใช้เครื่องช่วยหายใจ : กรณีศึกษา

Abstract

Abtract

            Introduction : Congestive Heart Failure (CHF) is a condition where the heart does not function efficiently, leading to insufficient blood supply to the body. It is a major cause of death worldwide, including in Thailand. Patients often experience symptoms such as shortness of breath, leg swelling, and pulmonary edema. Some cases require the use of ventilators, which increases medical costs and the workload for healthcare personnel. Therefore, nurses must possess the knowledge and skills to effectively care for critically ill patients and plan treatments.

            Objective : To study the nursing care of patients with heart failure who require ventilator support in the Respiratory Care Unit (RCU).

            Methods : A comparative study of two patients admitted to the Respiratory Care Unit (RCU) at Trang Hospital was conducted, covering the critical phase, continuous care phase, and discharge planning phase. The study was carried out from January 1, 2025, to March 31, 2025. Data collection tools included interviews, observations, and medical records.

            Results : Both patients presented with similar symptoms, including dyspnea, tachypnea, orthopnea, and pulmonary edema—common manifestations of acute heart failure. Both were diagnosed with heart failure and required mechanical ventilation in the Respiratory Care Unit (RCU). However, they had differing underlying conditions and risk factors. The patients received standard critical care nursing for mechanically ventilated patients, focusing on vital sign monitoring, airway management, diuretic administration (Lasix), and ventilator weaning protocols. Gordon's Functional Health Patterns and Orem's Nursing Theory guided nursing care by assessing health status, planning interventions, and formulating nursing diagnoses.Case 1 posed challenges due to severe myocardial dysfunction and high-risk behavior (smoking), which hindered recovery. Additionally, a history of inconsistent treatment adherence increased the risk of recurrence. Case 2 was complicated by a hypertensive crisis and atrial fibrillation, requiring meticulous medication management and close monitoring for complications. Both patients successfully stabilized without severe complications and were effectively weaned off mechanical ventilation.

Keywords : Nursing care, Heart failure, Ventilator use, Orem's Nursing Theory