- 期刊
一位急性肺水腫病人接受連續性腎臟替代治療之加護經驗
The Nursing Experience of an Acute Pulmonary Edema Patient Receiving Continuous Renal Replacement Therapy in an Intensive Care Unit
摘要
本文旨在探討一位因急性肺水腫合併急性腎衰竭的個案採連續性腎臟替代治療之加護經驗。照顧期間自2017年1月24日至2月2日，以身體評估、直接照護、觀察、實驗室數據、病歷查閱等方式收集資料，運用全人五大健康層面進行評估、分析與歸納，確立護理問題有氣體交換功能障礙、體液容積過量、潛在危險性感染、焦慮。照護過程中，緊急進行機械性通氣治療，依循呼吸訓練照護計畫及選擇連續性腎臟替代治療，清除體內過多液體容積改善肺水腫，成功脫離呼吸器。個案因雙耳重聽產生溝通障礙，且因置放氣管內管無法言語表達，護理人員透過主動關懷、身體語言、運用生理需求圖卡輔助下，提供心理層面持續性照護與陪伴，增進護病間的信任感，降低焦慮問題。期望藉此護理經驗，提供臨床護理人員對日後照護此類病人之參考。
並列摘要
This case report describes the nursing experience of a patient in an intensive care unit (ICU) who had acute pulmonary edema complicated with acute renal failure receiving the continuous renal replacement therapy. During the caring period, from January 24, 2017 to February 2, 2017. The author collected data by physical assessment, direct care, observation, laboratory data and medical record. Using the holistic health care model, we found the case's major health problems, such as impaired gas exchange, excessive fluid volume, risk for infections, and anxiety. In the process of caring, we used mechanical ventilation, continuous renal replacement therapy (CRRT) to remove excessive fluid in the body for pulmonary edema and successfully weaning off ventilator. In the case of hearing impairment patient with endotracheal intubation, nursing staffs provided continuous psychological caring and accompanying by active care, body language, flashcards, the trust, and reduced anxiety problems. It is hoped that this experience can be used as a reference for clinical nurses to care such patients in the future.