協助一位重症肌無力個案脫離呼吸器之護理經驗

Nursing Experience with a Myasthenia Gravis Patient being Weaned from a Mechanical Ventilator

李榮真(Jung-Chen Lee) ； 楊佩瑄(Pei-Hsuan Yang)

《高雄護理雜誌》 25卷1期 (2008/05) Pp. 97-109

https://doi.org/10.6692/KJN-2008-25-1-9

摘要

本文是筆者照顧一位因重症肌無力引發呼吸衰竭個案脫離呼吸器之護理經驗，在照護期間（2005年10月22日至2005年11月01日）以Gordon十一項功能性健康評估為評估指引，並運用觀察、會談及查閱病歷等方法收集資料，發現個案有呼吸道清除功能失效、營養狀況改變：少於身體所需、睡眠型態紊亂、中度呼吸機戒斷功能失常、不確定感等健康問題。
在護理過程中筆者發現個案家庭支持系統不足，且缺乏對疾病的認知，主動連繫社工人員介入，進一步了解可運用的社會支持系統，並透過其他醫療團隊協助病患面對疾病，接受積極的治療。筆者在護理期間運用護理評估發現問題，提供與疾病相關的資訊，與個案建立良好護病關係後，引導個案表達其不安及期望，給予心理支持，降低個案對脫離呼吸器過程的焦慮，並透過適當的護理措施，提供個案身體舒適與心理支持，使個案能順利脫離呼吸器。

關鍵字

重症肌無力 ； 呼吸衰竭 ； 脫離呼吸器

並列摘要

This article documents the experience of the author caring for a patient with Myasthenia Gravis and initiated respiratory failure to be successfully weaned from a mechanical ventilator. The weaning process dated from October 22, 2005 to November 01, 2005, Through Gordon's 11 functions of health appraisal as the appraisal Guide, and based on observation, discussion and medical records, the author noted the following health-related problems including ineffective airway clearance, nutrition deficit, sleep pattern disturbance, dysfunctions of respiratory muscles, feelings of uncertainty, and health decision conflicts.
During the nursing process, the author discovered that the patient had poor family support and lacked understanding of her own disease conditions.
The author actively introduced social workers. Through their interventions, the author gained further understanding of the available resources of our community support system. Through the help of the medical team, the patient was able to face her disease condition and accepted aggressive management.
During the caring period, the author utilized nursing evaluation to discover problems, provided the patient with disease-related health information, established a proper patient-nurse relationship, helped the patient to express her uncertainty and expectations, provided psychological support, and helped lower her anxiety and fear toward the weaning process. Thoroughly appropriate nursing care, physical comfort and mental support were provided, to help the patient be successfully weaned from the mechanical ventilator.

並列關鍵字

Myasthenia Gravis ； Respiratory failure ； weaning from ventilator