協助一位初次呼吸衰竭脫離呼吸器個案之護理經驗

A Nursing Experience of Assisting a Patient with Respiratory Failure in Weaning Off the Ventilator

田久芸(Jiu-Yun Tian) ； 張聿仁(Yu-Jen Chang) ； 王靜慧(Ching-Hui Wang) ； 柯秀錦(Hsiu-Ching Ko)

《領導護理》 17卷2期 (2016/06) Pp. 47-57

https://doi.org/10.29494/LN.201606_17(2).0005

摘要

本文是探討一位初次插管使用呼吸器個案，進住加護室治療，經由呼吸肌力訓練成功脫離呼吸器之護理經驗。筆者自2014年1月2日至1月23日運用Gordon十一項健康功能型態為護理評估導引，藉由實際照護、觀察、紙筆溝通及查閱病歷資料等方式，分析歸納主要健康問題有：呼吸道清除功能失效、活動無耐力、焦慮，運用跨領域醫療團隊合作的照護模式，耐心地運用筆談認同個案的感受，建立良好的護病關係，降低其焦慮及呼吸困難的感受，並配合執行復健運動，終能順利脫離呼吸器並適時介入出院準備服務，協助轉至普通病房進而返家。希望藉此護理經驗分享，提供護理人員日後照顧此類個案的實務參考。

關鍵字

呼吸衰竭 ； 加護照顧 ； 復健運動 ； 脫離呼吸器

並列摘要

This article explores a nursing experience of assisting an intubated patient with respiratory failure in weaning off the ventilator in ICU. The nursing period was from January 2 to 23, 2014. With the Gordon's 11 Functional Health Patterns assessment tool, the author collected data through direct patient care, patient observation, patient interview in writing, and medical chart review. The identified three major health problems were ineffective airway clearance, physical activity intolerance, and anxiety. With a multidisciplinary care model, the team emphasized the patient's feelings, built a good therapeutic relationship with the patient, reduced the patient's anxiety and difficulty with breathing, and implemented a rehabilitation program. The patient could eventually remove the ventilator and start preparation for discharge. The patient was transferred to a regular medical floor and then later discharged home. The author hopes to share this nursing experience with those who will take care of patients in similar situations in the future.

並列關鍵字

respiratory failure ； intensive care unit ； rehabilitation exercise ； weaning mechanical ventilator

參考文獻

林佳慧 、 陳玉如 、 蔣立琦 ( 2013 ) . 應用跨專業領域團隊之時症醫療促進臨床個案安全與照護品質 , 榮總護理 , 30 ( 2 ) , 121-129 • doi:10.6142/VGHN.30.2.121

Cameron, S., Ball, I., Cepinskas, G., Choong, K., Doherty, T. J., Ellis, C. G., ? Fraser, D. D. (2015). Early mobilization in the critical care unit: A review of adult and pediatric literature. Journal of Critical Care, 30(4), 664-672. Doi: 10.1016/j.jcrc.2015.03.032

Engstrom, A., Nystrom, N., Sundelin, G., & Rattray, J. (2013). People's experiences of being mechanically ventilated in an ICU:A qualitative study. Intensive and Critical Care Nursing, 29 (2), 88-95. Doi:10.1016/j.iccn. 2012.07.003

Karlsson, V., Lindahl, B., & Bergbom, I. (2012). Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study. Nursing Inquiry, 19(3), 247-258. Doi:10.1111/j.1440-1800.2011.00576.

Volsko, T.A. (2013). Airway clearance therapy: finding the evidence. Respiratory Care, 58(10), 1669-1678. Doi:10.4187/respcare.02590 X