協助一位心臟衰竭個案持續心肺運動成功脫離呼吸器之照護經驗

本文描述一位心衰竭長期依賴呼吸器個案，入住呼吸照護病房經漸進式呼吸訓練及復健運動成功脫離呼吸器的照護經驗。筆者自2016年12月23日至2017年5月2日，運用Gordon 11項健康功能型態評估，藉由觀察、陪伴傾聽、身體評估等方式收集資料，發現主要護理問題有：呼吸機戒斷反應功能失常／咳痰能力及呼吸肌力不足、活動無耐力／心輸出量減少、裝置氣切發聲閥的照護知識缺失／與缺乏訊息提供有關以及焦慮／擔心呼吸器脫離失敗等健康問題，經由深呼吸訓練腹肌增進咳痰能力以維持呼吸道通暢，採漸進合適的呼吸器脫離模式PSV+PS、Tracheal mask進行呼吸器脫離訓練，並隨時評估呼吸型態反應，藉由心肺耐力運動包括：腳踏復健器、爬樓梯、步行6分鐘距離等增進活動耐力；提供雙耳耳塞使用及藥物輔助，提升睡眠品質；利用氣切發聲閥增進語言溝通，鼓勵說出心理的需求增進正向想法與自信，以降低焦慮，能主動積極配合執行復健運動，進而順利脫離呼吸器。建議對於此類長期脫離訓練病人，除了解決生理的問題更應該持續有耐心的關懷與陪伴個案，度過失敗挫折的經歷，增進照護品質達到最終目標。提供此照護經驗與護理同仁分享，作為日後照顧類似個案之參考。

關鍵字

心衰竭；脫離呼吸器；活動無耐力；焦慮

並列摘要

Purposes: This article describes a patient with heart failure who had a long-term ventilator dependence and was admitted to the respiratory care unit and successfully weaned from ventilator use by progressive breathing training and rehabilitation exercise. The author provided care from December 23, 2016 to May 2, 2017. By using Gordon's 11-item functional health pattern assessment and collecting data by observation, companionship, listening, physical assessment, and so on, the following main problems in nursing were identified: dysfunctional ventilatory weaning response/insufficient expectoration ability and respiratory muscle strength, lack of activity tolerance/reduced cardiac output, lack of knowledge for the care of the tracheostomy speaking valve/health problems related to poor accessibility to information, and anxiety/concern about weaning failure. Expectoration ability was enhanced through abdominal muscle training by deep breaths to maintain airway patency. Ventilator weaning training was performed by adopting an appropriate progressive ventilator weaning model and a tracheal mask, and real-time assessment of breathing pattern response was performed. Cardiopulmonary tolerance exercise included rehabilitation with a pedaling device, climbing stairs, and 6-minute walking to enhance activity tolerance. Earplugs and drugs were provided to improve sleep quality. A tracheostomy speaking valve was used to enhance verbal communication. Patients were encouraged to speak out their psychological demands, and positive ideas and confidence were enhanced; thereby, anxiety was reduced, and the patient actively cooperated in the rehabilitation exercise and uneventfully weaned from the ventilator. For patients undergoing long-term weaning training, in addition to solving the physiological problems, continuous care and patience to assist them through the experience of weaning failure, improvement of the quality of care, and achieving the ultimate goal are suggested. I hereby share this nursing experience with nursing peers as a reference for providing care for similar cases in the future.

並列關鍵字

Heart failure ； Ventilator weaning ； Activity intolerance ； Anxiety

國際替代計量

協助一位心臟衰竭個案持續心肺運動成功脫離呼吸器之照護經驗

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