一位插管導致聲帶麻痺行氣切手術後病人之護理經驗

本文描述一位車禍後插管導致聲帶麻痺行氣切手術後之個案護理經驗，護理期間為2014年1月12日至1月28日，筆者以觀察、筆談、病歷查閱、身體評估等方式收集資料，運用Gordon十一項健康功能型態進行評估，歸納出個案主要有「呼吸道清除功能失效」、「焦慮」、「身體心像紊亂」等健康問題。筆者除了嚴密監測及穩定個案生命徵象、建立良好護病關係之外，更提供完善之護理措施，尤其針對心理層面護理措施包括：請家屬攜帶熟悉的物品、佈置熟悉的環境、運用音樂治療、增加陪伴時間等，並鼓勵家屬肢體碰觸以增加病人安全感、提供正向支持鼓勵，引導病人說出自己的想法，協助度過失落及挫折，重新接受自我身體的改變、肯定及面對自己，並藉由醫護團隊協助個案尋求問題解決方法，達到身心靈舒適。

關鍵字

聲帶麻痺；氣切照護；呼吸道清除功能失效；焦慮；身體心像

並列摘要

This paper describes the nursing experience of a car accident patient following a tracheostomy for treating vocal cord paralysis caused by intubation over a period from January 12 to 28, 2014. The author collected data through observation, written communication, consultation with medical records and physical assessment, assessed the data using Gordon's 11 Functional Health Patterns, and concluded that the patient mainly had these health problems, including failure of the airway clearance function, anxiety and body image disturbance. In addition to close monitoring, stabilizing vital signs and building a good nurse-patient relationship, the author also provided comprehensive nursing measures, especially those for mental health, including asking the patient's family to bring objects familiar to the patient, setting up a familiar environment,giving music therapy, increasing accompaniment, encouraging physical contact with the patient from the family to increase the patient's sense of security, providing positive support and encouragement, guiding the patient to voice her thoughts, assisting the patient to overcome loss and frustration, embracing changes in the body, affirming and facing herself, and having the medical team to help the patient find solutions to her problems to achieve physical, mental and spiritual well-being.

並列關鍵字

vocal cord paralysis ； tracheostomy care ； ineffective airwayclearance,anxiety ； body image

參考文獻

Megarbane, B., BeHong, T., & BeHong, R. (2010, Mar.23). Early laryngeal injury and complications because of endotracheal intubation in acutely poisoned patients: a prospective observational study. Clinical Toxicology, 48, 331-336. doi:10.3109/15563651003801117

吳國湘、蕭自佑、古世基、陳佳慧（2014）‧長期經口氣管插管在口腔、咽、喉及氣管之合併症‧台灣醫學，18（5），580-584。