一位長期臥床老人合併肺炎再入院之照護經驗

本文探討一位長期臥床老人合併肺炎再入院之護理經驗，自2020年4月12日至2020年4月22日照護期間，以個案為中心，評估病人的生理、心理、社會、靈性等四大層面，並透過觀察、身體評估、家屬訪談、病歷查閱等方式收集資料，確立個案有呼吸道清除功能失效、皮膚完整性受損、身體活動功能障礙的健康問題。護理過程中教導照顧者了解翻身技巧、輔具使用、扣擊拍背、口腔衛生清潔及皮膚照護，並教導每日執行被動關節運動以維持身體功能不再惡化。此外再與家屬討論個案照護計畫時讓外籍照護工一起參與共同擬訂，藉由回覆示教的方式指導外籍照護工照護技巧，讓所有照護不因出院而有所中斷。透過照護本個案，深刻體會長期臥床的病人返家後有持續性的照護是很重要的，需要提供正確的照護知識及技巧，並確保主要照顧者可以正確執行，以提升個案返家後的照護和整體生活品質。藉此護理經驗，提供臨床護理師參考，讓此類病人得以順利出院且返家後可以得到持續性的照護。

關鍵字

長期臥床；肺炎；呼吸道清除功能失效；皮膚完整性受損；身體活動功能障礙

並列摘要

This article discusses the nursing experience of a long-term bedridden elderly man with pneumonia who was readmitted to the hospital. During the nursing period from April 12 to 22 in 2020, by focusing on this case, the four aspects of patient's physical, psychological, social, and spiritual were evaluated. Data were collected through observation, physical assessment, family interviews, and medical record review and it was established that the case has health problems such as respiratory clearance failure, skin integrity impairment, and physical activity dysfunction. During the caring process, the caregiver was educated on turning over skills, usage of assistive devices, back-slapping, oral hygiene and skin care, and perform daily passive joint movements to maintain body function from deterioration. In addition, when discussing the care plan for the case with the family members, allow the foreign caregiver to participate during the process, and guide him or her about care skills by responding as educated, aiming for no interruption of caring after discharge from the hospital. Through caring for this case, the author understood thoroughly the importance of having continuous care after a long-term bedridden patient returns home. It is necessary to provide correct care knowledge and skills to ensure that the primary foreign caregiver can perform them precisely, so as to improve patient's care and overall life quality. This nursing experience can hopefully provide reference for clinical nurses, so that such patients can be discharged smoothly and receive continuous care after returning home.

並列關鍵字

long-term bedridden ； pneumonia ； failure of airway clearance ； impaired skin integrity ； physical activity dysfunction

參考文獻

白淑芬、張國軒、林秀娜、蔡美菊、張宏哲（2017）．接受居家護理老人住院情形及其相關因素探討．長期照護雜誌，21(1)，53-75 。 https://doi.org/10.6317/LTC.21.53

林筱青、許晉豪、張簡志炫、楊正三（2016）．不同的皮膚照護方案對成人失禁性皮膚炎之改善成效：系統性文獻回顧．南臺灣醫學雜誌， 12(2) ， 103 - 114 。https://doi.org/10.6726/MJST.201612_12(2).0007

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張麗銀、尤琇慧、聶曉琪、彭素貞（2021）．減壓床墊預防壓力性損傷之成效研究．榮總護理，33(1) ， 260-268 。 https://doi.org/10. 6142/VGHN

國際替代計量

一位長期臥床老人合併肺炎再入院之照護經驗

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