一位胸腺癌病患併發肺炎導致呼吸衰竭之照護經驗

本文描述一位罹患胸腺癌病患併發肺炎導致呼吸衰竭而無法脫離呼吸器之照護經驗。護理期間自2009年8月12日至9月1日，藉由直接護理、觀察、身體評估及紙筆溝通方式收集資料，運用Gordon十一項功能性健康護理評估，確立個案有「氣體交換功能障礙」、「活動無耐力」、「無望感」護理問題。針對個案護理問題提供個別性護理措施，密切監測血氧飽和濃度，並協助促進痰液排除以維持呼吸道通暢；提供胸腔復健運動增加呼吸肌的肌力與耐力，增加通氣量和攝氧量；因短時間無法脫離呼吸器的心理壓力，給予主動關懷及同理的態度引導個案表達內心感受，檢視其無望感的程度，透過會談減少負向的自我言詞，以適時增加會客次數及教導放鬆技巧，並引導家屬運用親情的撫慰、支持陪伴的態度增加其安全感及正向情緒，使個案能以健康的態度面對疾病，成功渡過因疾病帶來的身心不適。

關鍵字

胸腺癌；肺炎；呼吸衰竭

並列摘要

This article describes the nursing experience for a patient with thymic carcinoma complicated by pneumonia and respiratory failure that led to weaning failure. During the caring period between 12th, August and 01st. September, 2009, data was collected by direct caring, observing, physical assessment and conversation by writing. Assessment based on Gordon's 11 functional health patterns enabled us to identify the patient's problems, including impaired air exchange, activity intolerance and hopelessness. The patient was provided with individualized nursing care, including close monitoring of oxygen saturation and assisting to promote the coughing up sputum in order to maintain airway patency. Improvement in respiratory muscle strength and endurance was achieved by rehabilitation exercises, which consequently increased ventilation and oxygen uptake. As the psychological stress due to weaning was impossible to be avoided in a short period of time, the patient was offered with proactive care and empathy that led him to express feelings and to reduce the extent of hopelessness. The negative self-talk words were reduced by conversations, increasing meeting frequency and leaching relaxation techniques in a timely manner. His family were guided to use family's comfort and to accompany him with supportive attitude for increasing positive emotions and security sense, which enabled the patient to have a healthy attitude towards the disease for overcoming the physical and mental discomfort.

並列關鍵字

thymic carcinoma ； pneumonia ； respiratory failure

國際替代計量

一位胸腺癌病患併發肺炎導致呼吸衰竭之照護經驗

全文下載

主題瀏覽