一位感染COVID-19合併急性呼吸窘迫症候群病人之加護護理經驗

COVID-19疫情爆發初期資訊匱乏，病人確診後需入住負壓隔離病房，一旦病人出現急性呼吸道窘迫症候群的併發症，除了需面臨死亡的恐懼以外，也會讓病人及家屬出現焦慮不安的情緒。本文描述一位疫情初期感染COVID-19合併ARDS的加護護理經驗，照護期間為2020年3月31至5月8日，以Gordon十一項健康功能型態進行整體性評估，確立主要健康問題為氣體交換障礙、活動無耐力、焦慮。在照護過程透過遠端生理監視系統監測生命徵象，藉由跨團隊合作由護理師觀察與監測呼吸器參數，使用拍痰墊促進痰液排除，協助抽痰及監測呼吸型態，反饋身體評估結果，密切與醫師、呼吸治療師、復健師等團隊成員討論，最後穩定病人血氧狀況；呼吸器治療期間積極介入復健運動，從而提升活動耐力；藉由主動關懷與陪伴，運用通訊軟體協助病人與家人視訊，減輕焦慮問題，最後終能讓病人康復，早日回歸正常生活，因此期望以此照護經驗提供臨床照護之參考。

關鍵字

COVID-19 ；新型冠狀病毒；隔離；急性呼吸道窘迫症候群

並列摘要

Accurate information on COVID-19 was difficult to obtain during the early stages of the COVID-19 pandemic, leading to patients being admitted to negative pressure isolation wards upon diagnosis. Patients who developed acute respiratory distress syndrome (ARDS), which is a risk factor for death, were at risk of anxiety. Family members of such patients were also at risk of anxiety. This article describes the intensive care nursing experience of a patient with COVID-19 and ARDS during March 31 to May 8, 2020. Gordon's eleven functional health patterns were used to comprehensively identify major health problems, such as gas exchange disorder, activity intolerance, and anxiety. During the care process, the patient's vital signs were recorded using a remote physiological monitoring system. This approach facilitated cross-team collaboration, allowing nurses to closely interact with doctors, respiratory therapists, and rehabilitation therapists. Key interventions included monitoring ventilator parameters, using chest wall percussion for sputum elimination, assisting in sputum extraction, monitoring breathing patterns, and providing feedback on physical assessment results, all contributing to stabilizing the patient's blood oxygen levels. Furthermore, early rehabilitation during intubation was implemented to improve limb mobility. In addition, companionship and the use of communication software for video calls between the patient and their family were instrumental in alleviating anxiety and aiding in the patient's swift recovery. The findings from this study may serve as a reference for clinical care in similar situations.

並列關鍵字

COVID-19 ； coronavirus disease ； isolation ； acute respiratory distress syndrome

參考文獻

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