一位肺病末期病人使用非侵襲性正壓呼吸器之照護經驗

Nursing Experience of Patients with End-Stage Lung Disease and Adaptation to Non-invasive Positive Pressure Ventilator

龔怡心(Yi-Hsin Kung) ； 宋聖芬(Sheng-Fen Sung)

《高雄護理雜誌》 36卷2期 (2019/08) Pp. 85-97

https://doi.org/10.6692/KJN.201908_36(2).0008

摘要

本文描述一位肺病末期病人想與上帝爭時間、延長與家人相處時光，迫需使用非侵襲性正壓呼吸器（NIPPV），進而圓夢安心返家之護理經驗。2016年8/18－9/7筆者經高登十一項功能性健康型態為評估工具，藉觀察、會談、身體評估及病歷查閱等方式收集資料，發現個案有低效性呼吸型態、焦慮、營養少於身體所需及照顧者角色緊張等健康問題。因肺病末期不易判斷及醫療處置不確定絕對有利的情況下，經家庭會議與安寧、呼吸治療、出院準備服務等跨專業團隊共同討論，藉以關懷、同理心與個案家屬建立互信關係，引導個案面對疾病末期所帶來的衝擊及家屬內心擔憂之事，完成個案返家心願。

關鍵字

肺病末期 ； 非侵襲性正壓呼吸器 ； 照護

並列摘要

This article describes a patient with End-Stage Chronic Obstructive Pulmonary Disease (COPD), with the desire to prolong his time with his family and spend time before God, undergo the nursing experience to realize his return home, but is forced to use a non-invasive positive pressure breathing device (NIPPV). The author collected data through direct observations, interviews, medical records, and applied Gordon's 11 Functional Health Patterns to comprehensively assess the patient. The health problems of the patient were identified as follows: low effective breathing pattern, anxiety, nutritional imbalance less than body requirements, and caregiver role strain. Due to the difficulty in judging the end stage of COPD and the uncertainty of medical treatment, we attempted to build a relationship of mutual trust and empathy to foster stronger nurse-patient relationships, then gave assistance to both patient and family through family conference to promote shared decision-making for the patient with nurses and physicians, the hospice team, the respiratory therapy team, and the discharge preparation service interdisciplinary team, allowing the patient to achieve discharge and return home.

並列關鍵字

End-Stage of Lung Disease ； Non-invasive Positive Pressure Ventilator (NIPPV) ； Nursing Experience

參考文獻

楊嘉禎、王品鈞、陳玉如(2015)．找回慢性阻塞性肺病病人理所當然的呼吸．源遠護理，9(2)，11-20。

雷琇惠、林俐伶(2015)．慢性肺阻塞疾病病人女性配偶的照護負荷與生活品質之相關探討．馬偕護理雜誌，9(2)，15-27。

黎瑞萍、李淑靜、陳乃萍、王穹道、洪宗杰(2012)．阻塞性肺病末期病人使用限期嘗試性治療的照護經驗，安寧療護雜誌，17(2)，210-220。

Amri, M. V., Monadi, M., Heidari, B., Maleh, PA., & Bijani, A. (2016). Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease. Caspian Journal of Internal Medicine, 7(2), 99-104.

Dai, B., Kang, J., Sun, L. F., Tan, W., & Zhao, H.W. (2012). Vibration response imaging: a novel noninvasive tool for evaluating the initial therapeutic effect of noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. The Journal of Respiratory Research, 13(1), 65-75.