運用肺部復健於一位A型流感重症個案脫離呼吸器的照護經驗

Pulmonary Rehabilitation as an Effective Weaning Method in a Patient with Severe Complicated Influenza-A Nursing Experience

黃憶環(Yi-Huan Huang) ； 許桂菱(Kuei-Ling Hsu) ； 戴雪萍(Hsueh-Ping Tai)

《榮總護理》 34卷1期 (2017/03) Pp. 21-28

https://doi.org/10.6142/VGHN.34.1.21

摘要

本文描述一位A型流感重症合併急性呼吸窘迫症候群使用呼吸器的個案，期間經歷一次拔管失敗，重新放置氣管內管，最後成功脫離呼吸器所引發的生、心理問題之照護經驗，護理期間自2014年6月23日至2014年7月6日，藉由觀察、身體評估、筆談、查閱病歷等方式收集相關資料，運用Gordon十一項功能性健康評估為架構，確立個案主要健康護理問題有：一、呼吸道清除功能失效；二、睡眠型態紊亂；三、焦慮。針對護理問題於照護期間協助團隊執行肺部復健運動提升呼吸肌耐力，教導有效性的深呼吸咳嗽運動及背部叩擊使深部痰液容易咳出；提供合適睡眠環境配合音樂治療及肌肉放鬆技巧改善睡眠品質；藉由陪伴支持並鼓勵個案表達心理感受，增強自信心，讓個案參與呼吸器脫離計畫，緩解其焦慮問題，達到成功脫離呼吸器及全人護理之目標。此照護經驗將有助提升護理專業照護品質及爾後同仁執行肺部復健措施於臨床照護之參考，也建議將呼吸器脫離過程及肺部復健運動製成影片光碟或手冊，讓個案家屬清楚明瞭呼吸器脫離過程。

關鍵字

肺部復健 ； 流感重症 ； 脫離呼吸器

並列摘要

This case report describes our nursing experience of successful ventilator weaning for a patient with influenza A infection complicated with acute respiratory distress syndrome. A 46 year-old man had severe influenza without any underlying diseases. He received reintubation due to rapid shallow breathing and cold sweating after extubation. We collected data from June 23 to July 6, 2014, from clinical observations, physical examinations, patient feedback, progress notes, and a multidisciplinary team conference. According to Gordon' 11 functional health patterns, the patient had ineffective airway clearance, sleep pattern disturbance, and anxiety. We administered a pulmonary rehabilitation program that included exercises aimed at improving respiratory muscular endurance, breathing and coughing, and chest percussion. We also provided a comfortable environment, musical therapy, and education on muscle relaxation techniques to improve sleep quality. To relieve his anxiety, the patient received adequate company and mental support and was encouraged to express his feelings. These methods were found to be successful in weaning him off the ventilator and providing holistic health care. Our experience may provide a reference for performing pulmonary rehabilitation. A well-designed educational handout or video may be helpful in clinical practice.

並列關鍵字

pulmonary rehabilitation ； severe complicated influenza ； ventilator weaning

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