- 期刊
照顧一位慢性阻塞性肺疾病老年病人反覆入院之加護經驗
Experience of Nursing an Elderly Patient With Chronic Obstructive Pulmonary Disease Undergoing Repeated Hospital Admission
摘要
本文是在敘述一位慢性阻塞性肺疾病老年病人，曾因肺部感染多次反覆住院，此次再次被診斷為肺炎合併肋膜積水入院治療的護理經驗，筆者自2019年3月8日至2019年3月18日期間，以直接照護、觀察、會談及病歷查閱等方式收集資料，確認主要健康問題為（一）氣體交換障礙／與肺部感染導致痰多無法自咳；（二）活動無耐力／與呼吸肌及四肢肌力減退；（三）焦慮／與擔心疾病對生命有威脅及陌生環境。筆者透過按時給予及監測抗生素使用，配合叩擊、震顫等物理方法，使肺炎早日獲的控制以改善氧合狀況。也與復健師共同設計並執行病人肺部復健計畫，增強呼吸肌耐力，改善活動無耐力，進而順利脫離正壓呼吸器。因反覆入院且首次住進加護病房，陌生環境加上本身雙耳重聽產生的溝通障礙，導致焦慮等負面情緒，彈性增加會客時間，降低病人對陌生環境上及溝通障礙導致的焦慮問題，透過與醫療團隊的合作，提供適當的照護，使病人情況逐日好轉，順利轉出加護病房。
並列摘要
This article describes the experience of nursing an elderly patient with chronic obstructive pulmonary disease who had been hospitalized repeatedly because of lung infections. The patient had pneumonia and pleural hydrops, not for the first time. Data were collected from March 8 to March 18, 2019, using observations, interviews, medical records. The patient's most urgent health problems were confirmed to be (1) gas exchange disorder and lung infection leading to excessive phlegm and an inability to independently cough, (2) activity intolerance and reduced respiratory muscle and limb muscle strength, and (3) anxiety regarding life-threatening diseases and unfamiliar environments. The author designed and implemented a pulmonary rehabilitation plan for the patient on the basis of a literature review. The plan involved training the patient's respiratory muscles and reducing his activity intolerance followed by weaning him off a respirator. The patient had recently been admitted to an intensive care unit for the first time. The unfamiliar environment of the intensive care unit and communication problems due to the patient's binaural hearing loss caused him to experience anxiety and other negative emotions. Symptoms such as respiratory failure were relieved through noninvasive pressure respirators, and a patient-centered pulmonary plan was developed. Rehabilitation exercises and a flexible increase in visiting hours provided positive encouragement to reduce the patient's anxiety and minimize the patient's risk of readmission. The nursing staff maximized the quality of their care. Overall, in the present case, the author interacted and cooperated with the medical team to ensure high-quality and comprehensive individual care tailored to the needs of the patient.