一位母體內胎兒溶血導致水腫之早產兒的加護護理經驗

The Intensive Care Experience of a Preterm Infant with Hydrops Fetalis

柯惠如(Hui-Ju Ke) ； 陳永娟(Yong-Chuan Chen) ； 張瑛瑛(Yin-Yin Chang)

《榮總護理》 31卷3期 (2014/09) Pp. 306-313

https://doi.org/10.6142/VGHN.31.3.306

摘要

本文描述一位妊娠33^(+2)週、出生體重2500公克，因母體內胎兒溶血導致水腫之早產兒及其父母的加護護理經驗。照護期間自2012年8月2日至8月14日，藉由參與照護、直接觀察、身體評估及病歷查閱等方式收集資料，運用Gordon十一項功能性健康型態評估技巧，發現個案有氣體交換障礙、混亂性嬰兒行為及潛在危險性腦損傷等主要健康問題，因是特殊少見案例而引發撰文動機。過程中從生產時通知兒科醫護團隊至產房待命，出生後由兒科醫師在產房緊急插管處置及轉送，轉入新生兒加護病房給予腹水放液、換血及照光等處置與加強照護，並運用新生兒個別化發展性照護措施促進其行為之統合，提供以家庭為中心之照護，成功解決個案健康問題。建議有類似個案應進行跨部科之個案討論與醫療團隊經驗分享，提升醫療團隊照護品質。期望藉由本個案報告分享照護經驗，提供日後護理同仁之參考。

關鍵字

早產兒 ； 胎兒溶血 ； 高膽紅素血症

並列摘要

This paper details an experience of providing intensive care for a preterm infant with hydrops fetalis from August 2 to August 14 in 2012. Data were collected through observations, interviews, chart reviews, and discussions with the medical team. Moreover, physical examinations, continuity of care, and the Gordon's 11-item functional health patterns were used to identify the patient's health problems and corresponding nursing problems. Subsequently, three nursing problems were diagnosed: impaired gas exchange, irregular infant behavior, and brain injury that may result in permanent damage. To mitigate these problems, the author not only performed treatment programs including intubation, exchange transfusion, and intensive phototherapy with a medical team but also provided mental support to the patient's parents by engaging them in empathetic conversations. To improve the quality of care given to patients with hydrops fetalis, medical teams and health care professionals can consult this report to further understand the condition.

並列關鍵字

preterm infant ； fetal immunization hemolysis ； hyperbilirubinemia