一位肺炎併發急性呼吸窘迫症候群患者之照護經驗

本文探討一位罹患肺炎引發急性呼吸窘迫症候群的老年女性，因使用呼吸輔助機導致身心不適，且難以預測病情變化致衍生無力感之照護經驗。護理期間為2014年9月28日至2014年10月24日，筆者以觀察、會談及身體評估等技巧收集資料，運用羅氏適應模式進行整體性系統評估，發現個案出現氣體交換障礙、呼吸道清除功能失效及無力感等健康問題。照護期間運用關懷陪伴建立良好治療性護病關係，運用氧氣治療及呼吸器以保持血氧穩定濃度及有效控制感染，改善氧氣供需不平衡狀態；教導有效咳嗽及姿位引流技巧，輔以機械式胸腔叩擊，以利病人清除呼吸道分泌物；協助病人適應疾病變化及增強信念，肯定自我存在價值，降低對疾病產生的無力感。建議醫護同仁需加強個案及主要照顧者肺炎防治及居家照護技能，使其身、心皆獲得適切性照護及降低肺炎感染風險，期望經此照護經驗分享，以供臨床實務參考之用。

關鍵字

肺炎；急性呼吸窘迫症候群；無力感

並列摘要

This paper presents the experience of providing care to an older woman with acute respiratory distress syndrome (ARDS) caused by pneumonia. The patient experienced physical and psychological discomfort from ventilator use as well as powerlessness caused by unpredictable changes in her condition. The patient received care from September 28, 2014 to October 24, 2014. The author collected data by applying techniques such as observations, interviews, and physical assessment. Roy's adaptation model was employed to comprehensively and systematically assess the patient. The patient's health concerns included impaired gas exchange, ineffective airway clearance, and powerlessness. During her care, compassion and companionship were used to establish a beneficial therapeutic care relationship, oxygen therapy and ventilators were used to maintain the oxygen concentration, effective infection control was achieved, and oxygenation was improved. The patient was taught effective coughing and postural drainage techniques, assisted by mechanical chest percussion devices, to clear airway secretions. Finally, the patient was aided in adapting to changes in her condition, increasing her faith, affirming her value of existence, and reducing the powerlessness caused by her illness. We recommend the staff need to strengthen patients and primary caregivers for pneumonia prevention and home care skills.