一位地方性斑疹傷寒個案成功脫離呼吸器之護理經驗

Nursing Experience with an Endemic Typhus Patient Being Weaned from a Mechanical Ventilator

朱淑英(Shu-Ying Chu) ； 朱璧岑(Pi-Chen Chu)

《安泰醫護雜誌》 19卷3期 (2013/09) Pp. 1-14

摘要

本文描述一位地方性斑疹傷寒併發呼吸衰竭個案，成功脫離呼吸器之照護經驗。筆者於2011/02/09至02/20照護期間，藉由觀察、筆談、病歷查閱收集資料，並利用Gordon十一項健康功能型態評估，確立個案有呼吸道清除功能失效、身體活動功能障礙、不確定感、中度呼吸器戒斷反應功能失常等健康問題。在照護過程中發現個案除了生理症狀外，心理也面臨無法預期疾病的進展及預後，產生不確定感，引發焦慮及不安等負面情緒。筆者透過建立信任感及主動提供疾病訊息，重新建立個案對疾病的認知及觀念，進而提升對疾病的控制感，以減少不確定感；同時運用連結家庭關懷支持系統，並結合其他專業醫療團隊進行呼吸訓練，使個案順利完成治療，終於能成功脫離呼吸器。希望藉此照護經驗分享，作為護理同仁日後照護類似個案時之參考，以提升護理專業及照護品質。

關鍵字

地方性斑疹傷寒 ； 呼吸器脫離 ； 不確定性

並列摘要

This article prescribes an endemic typhus case complicated with respiratory failure. The patient was weaned successfully from the mechanical ventilator after a proper care process and treatment. The author collected data through observation, conversation, patient's chart report, and the assessment of Gordon 11 health functional patterns to ensure the case had the health problems including respiratory tract clearance dysfunction, physical activity disability, uncertain feeling, and a moderate dysfunctional ventilatory weaning response from 2011/02/09 to 2011/02/20. During the nursing process, the author discovered that the patient had psychiatric problems in addition to physical symptoms. The patient had a sense of uncertainty due to the unknown process and outcome of the treatment. The psychiatric problem also disturbed the patient and induced his anxiety. By establishing trust and offering disease information, the patient acquired enough knowledge about the treatment and was more confident to control the disease. At the same time, the author also associated the family supportive system and other professional medical teams about respiratory training. Therefore, the patient completed the treatment course and was successfully weaned from the mechanical ventilator. The author also hopes the experience can improve the nursing care profession and quality in the future.

並列關鍵字

Endemic typhus ； Weaning from ventilator ； Uncertainty