制約理論於呼吸器延遲脫離患者之應用

A Case Report: Apply Conditional Theory in the Patient with the Delay Ventilator Weaning

陳菀琪(Wan-Chi Chen) ； 葉莉莉(Lily-Lily Yeh)

《醫護科技學刊》 3卷4期 (2001/10) Pp. 365-374

https://doi.org/10.6563/TJHS.2001.3(4).7

摘要

本文藉由照護一位第七胸椎腫瘤術後無法脫離呼吸器患者，探討影響其呼吸器延遲脫離之心理因素。筆者於照護期間進行身體檢查與評估、並藉由會談(含筆談)、觀察、收集病史及與醫療團隊人員討論之方式收集個案及家屬之相關資料，以護理過程作內容整理。過程中應用主護護理接觸病瞭解個案，以主護理對呼吸器脫離有正向的策略，協助個案瞭解脫離情況已達成目標；除此外，學習理論中正回饋運用，讓個案努力訓練活動耐力及呼吸運動；生理回饋機制之應用，設定生命監測儀氣中血氧濃度、呼吸器中潮氣容積及呼吸速率之警鈴，透過聽覺信號(血氧濃度獲呼吸器警鈴聲響)傳達血氧濃度過低獲呼吸太淺、速率太快或慢，協助個案瞭解生命徵象及呼吸器正常與否，並加以控制這些變化；配合上述理論設計特定的呼吸脫離計劃，協助個案降低對呼吸器脫離之焦慮，並漸進式增加其活動耐受度，讓個案得以在使用呼吸器54天後，成功的脫離呼吸器。

關鍵字

呼吸器脫離 ； 主護護理 ； 生理回饋機制 ； 操作性條件化學習理論

並列摘要

This article reported a patient with excision the seventh thoracic vertebrae tumor, and to explore psychological factors with delay ventilator weaning. The patient's and his families’ data was collected through physical examination and assessment, interview (included writing interview), observation, taking illness history and discussion with the medical team, then wrote the nursing process to analyze contents in the period. The primary nursing and positive strategy were applied to contact and realize the patient, and assist patient understand and accomplish the goal of the ventilator-weaning circumstance. Then, the positive reinforcement of the conditional theory trained the patient's activity and breathing. The application of the mechanism of biofeedback, set up alarms of the SpO2 , ventilator’s tidal volume and respiratory rate, through the auditory signal (SpO2 or ventilator’s alarm) to transmit low SpO2 , shallow breathing and breathing frequency, helped the patient to understand his vital sign and breathing pattern, then controlled it. The specific ventilator weaning program decreased his anxiety and increased his activity, then succeed to get off ventilator after using it 54 days.

並列關鍵字

ventilator weaning ； primary nurse ； biofeedback mechanism ； conditional theory