一位吸入性肺損傷併發創傷後症候群個案之加護經驗

本文為一位27歲女性，因火災造成吸入性肺損傷插管併創傷後症候群症狀之加護經驗。筆者於照護期間2021年4月26日至5月2日，運用Gordon十一項功能性健康型態評估，藉由身體評估、陪伴及溝通等方式收集資料，確立個案有呼吸道損傷、急性疼痛、創傷後症候群等健康問題。護理期間透過監測動脈血液氣體、一氧化碳血紅素濃度、蒸氣吸入、高頻胸壁震盪機器促進痰液排出及與呼吸治療師討論執行呼吸訓練，成功改善肺部氧合功能和呼吸道水腫順利脫離呼吸器。創傷後病人情緒激動及明顯負面情緒，使用「中文版簡式創傷後壓力疾患量表」有效評估創傷後壓力之風險，透過跨團隊心理師、精神科醫師，擬定以家庭為中心的照護，提供個別性、連續性之身心照護，增強復原動力，利用書寫日記方式抒發情緒，使其緩解創傷後壓力。期望藉此次護理經驗分享，提供護理人員重視病人火災事件造成身心靈調適過程及復健轉介服務，作為日後照護此類病人之參考。

關鍵字

吸入性肺損傷；急性疼痛；創傷後症候群

並列摘要

This article described the nursing experience of a 27-year-old female who was intubated due to fire-induced inhalation injury and posttraumatic syndrome. During the nursing period from April 26 to May 2, 2021, the author used Gordon's eleven functional health patterns for physical assessment and communication. Nursing problems included inhalational injury, acute pain, and posttraumatic syndrome. Throughout the nursing period, the respiratory edema successfully improved by monitoring arterial blood gas and carboxylhemoglobin. By using steam inhalation and high-frequency chest wall oscillation to promote sputum discharge, and discussing with respiratory therapists to perform breathing training, not only the oxygenation function of the lungs and respiratory edema successfully improved, but also the ventilator was removed. The posttraumatic patient was emotionally agitated and had obvious negative emotions. Using the "Chinese version of SPAN" to effectively assess the risk of posttraumatic stress and through cross-team psychologists and psychiatrists, family-centered care was drawn up to provide individualized and continuous physical and mental care that could enhance recovery motivation. Additionally, the patient was encouraged to keep a diary to express emotions and relieve posttraumatic stress. It is hoped that this nursing experience sharing will provide nursing staff with attention to the physical and mental adjustment process and rehabilitation referral services of patients caused by fire incidents, as a reference for the future care of such patients.

並列關鍵字

inhalational injury ； acute pain ； posttraumatic syndrome

參考文獻

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