一位肺炎併急性呼吸衰竭個案之急診護理經驗

The Emergency Nursing Experience of Caring a Patient with Pneumonia and Acute Respiratory Failure

劉心瑋(Hsing-Wei Liu) ； 陳淑賢(Sue-Hsien Chen) ； 謝芳貴(Fang-Kuei Hsien)

《長庚護理》 28卷2期 (2017/06) Pp. 336-345

https://doi.org/10.3966/102673012017062802013

摘要

本文描述一位93歲男性罹患肺炎併急性呼吸衰竭，在面臨放置氣管內管覺得生命即將消失，考慮到氣管內管可能要長期留置，且致死亡時均無法脫離呼吸器甚至需終身臥床仰賴他人全責照顧。病人對未來無法預知結果，深度感覺生命受到嚴重威脅。2013年10月25日至10月27日的期間，筆者運用Gordon十一項功能性健康評估模式以直接會談、觀察、身體評估及病歷查閱進行評估，並且確立個案有呼吸道清除功能失效、睡眠型態紊亂及焦慮等健康問題，另外在住院期間，醫師運用半身人體模型及X光片向個案解釋病情進展及住院診療計畫與胸腔物理治療照護計畫，藉此改善與維持基本呼吸功能，並請家屬全程陪伴，提供支持、鼓勵個案筆述心中感受，進而降低焦慮，達成維持基本生理指標，順利脫離呼吸器之可能性，進而提昇個案對疾病治癒之信心。

關鍵字

呼吸衰竭 ； 呼吸道清除功能失效 ； 睡眠型態紊亂 ； 焦慮

並列摘要

This article described the nursing experience of caring a 93-year-old man having pneumonia complicated with acute respiratory failure. The patient felt that his life was likely to come to an end while experiencing endotracheal intubation. He strongly sensed that his life was threatened and felt scared due to the possible long-term use of the ventilator, which was something unable to be removed until his death, resulting in a permanent bedridden condition in need of total nursing care and an unknown future. During the nursing period from October 25 to 27 in 2013, the author evaluated the patient using Gordon 11 Function Health Patterns through direct meetings and conversations, observation, physical assessment, and reference to medical records for comprehensive health assessments. The results confirmed that the patient had several health problems, including ineffective airway clearance, sleep disorder, and anxiety. During his hospitalization period, an upper-half medical human model and X-ray films were utilized to explain his progress of health conditions, inpatient treatment planning, and the nursing plan of chest physical therapy. These plans were to improve and maintain the patient's basic respiratory functions. At the same time, his family was invited to stay with him during the whole process to offer support and encourage him to write down what he felt. By doing so, the author helped the patient to reduce anxiety, maintain normal physiological function, increase the possibility of successfully removing the ventilator and then further enhance the patient's confidence in recovery.

並列關鍵字

respiratory failure ； ineffective airway clearance ； disturbed sleep pattern ； anxiety

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