照顧一位呼吸窘迫症候群病人採俯臥治療之護理經驗

呼吸窘迫症候群是急重症單位常見的診斷之一，文獻顯示俯臥治療的確可改善該類病人的氧合狀況並降低死亡率。本文描述一位82歲女性因吸入性肺炎併呼吸窘迫症候群，入住加護病房接受俯臥治療之護理經驗。護理期間自2019年06月09日至2019年06月22日，運用Gordon十一項功能性健康型態評估為工具，彙整評估結果，發現個案有氣體交換障礙、潛在危險性皮膚完整性受損、焦慮等健康問題。運用俯臥治療及胸腔復健運動，來維持良好的血液動力學，進而達成移除氣管內管之目標；俯臥治療期間提供舒適擺位及減壓輔具，避免產生壓力性損傷；以正向鼓勵引導個案表達感受，連結家屬的支持力量來增加個案自我信心，使個案在心理焦慮層面得以調適。藉由此次個案的照護經驗，提供日後護理人員照護俯臥治療病人之參考。

關鍵字

呼吸窘迫症候群；俯臥治療

並列摘要

Acute Respiratory Distress Syndrome (ARDS) is one of the common diagnoses in the Intensive Care Unit (ICU). Previous studies showed prone position can indeed improve the oxygenation status of such patients and reduce the mortality rate. This study describes nursing experience of an 82-year-old female patient with aspiration pneumonia and ARDS when admitted to ICU. During the nursing period, from June 9 to June 22 in 2019, staff applied the Gordon 11 Function Health Patterns Assessment and revealed that the case had health issues such as gas exchange impairment, potential damage of skin integrity, and anxiety. By applying prone position and chest physical therapy to maintain good hemodynamics and therefore achieve the goal of removing the endotracheal tube; Provide comfortable positioning and decompression aids during prone treatment to avoid pressure injuries; Positive encouragement to guide the case to express emotions and connect support of family members to increase self-confidence and help the case to alleviate her anxiety. Based on the nursing experience from this case, provide a nursing reference for taking care of patients with prone position in the future.

並列關鍵字

acute respiratory distress syndrome(ARDS) ； prone position

參考文獻

呂淑如、王筱珮（2018）．俯臥通氣治療及其護理．護理雜誌，65(3)，96-102。https://doi.org/10.6224/JN.201806_65(3).13

李柏昕、王振宇、黃彥翔、李博仁、傅彬貴（2019）．急性呼吸窘迫症候群(ARDS)使用俯臥式通氣模式(Prone positioning)之預後影響因子探討．內科學誌，30，96-106。https://doi.org/10.6314/JIMT.201904_30(2).06

劉心瑋、陳淑賢、謝芳貴（2017）．一位肺炎併急性呼吸衰竭個案之急診護理經驗．長庚護理，28(2)，336-345。https://doi.org/10.3966/102673012017062802013

Gordon, A., Rabold, E., Thirumala, R., Husain, A., Patel, S., & Cheema, T. (2019). Prone positioning in ARDS. Critical Care Nursing Quartely, 42(4), 371-375.https://doi.org/10.1097/CNQ.0000000000000277

Guerin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., ... Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. The New England Journal of Medicine, 368(23), 2159-2168. https://doi.org/10.1056/NEJMoa1214103

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照顧一位呼吸窘迫症候群病人採俯臥治療之護理經驗

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