照顧一位敗血症引發呼吸窘迫症候群病人之加護經驗

Nursing Care Experience for a Patient with Septicemia Complicated with ARDS in the ICU

柯碧芬(Pi-Fen Ko) ； 蔡淑芳(Shu-Fang Tsai)

《高雄護理雜誌》 32卷3期 (2015/12) Pp. 32-42

https://doi.org/10.6692/KJN-2015-32-3-4

摘要

本文旨在探討一位因左腳外傷感染導致嚴重敗血症及肺炎，引發呼吸窘迫症候群之個案。照護期間自2012年8月27日至9月10日，筆者藉由觀察、會談、實驗室數據、家屬訪談等資料收集方法，運用Gordon十一項健康功能型態進行護理評估，發現主要健康問題有組織灌流失效、氣體交換障礙、焦慮等。照顧期間和醫療團隊進行討論及合作，依據早期目標導向敗血性休克治療準則進行體液調整，達血液動力學之穩定；執行呼吸窘迫症候群肺泡回復術計畫及照護措施，給予肺泡塌陷及呼吸訓練照護，改善肺部血流，使順利拔除氣管插管；另使用白板及筆鼓勵引導表達出心裡的感受，增加探視次數給予支持、同理與關懷，適時提供病情穩定之訊息，陪伴個案及案妻度過焦慮。重症敗血症的早期目標導向療法強調前六小時黃金時間及整體復甦，建議臨床多舉辦實際案例討論式之在職教育，以期為此類病人爭取寶貴時間，儘早達到休克復甦之目標，挽回病人寶貴的生命。

關鍵字

敗血症 ； 呼吸窘迫症候群 ； 早期目標導向療法

並列摘要

This case report explores the nursing experience of caring for a patient with sepsis, pneumonia, and adult respiratory distress syndrome (ARDS) due to left foot infection. The nursing care period was from August 27, 2012 to September 10, 2012. The Gordon functional health patterns were applied to guide the patient’s data collection and analysis. Data sources included observation, medical chart reviews, written communications with the patient, and interviews with family members. The health problems of the patient were tissue perfusion ineffectiveness, gas exchange impairment, and anxiety. The author had discussions and cooperated with the medical team concerning the patient’s condition. The most important goal was to correct the patient’s bodily fluids and maintain hemodynamic balance to prevent septic shock; additionally, giving respiratory training and lung recruitment maneuver for alveolar collapse to improve lung blood flow and gas exchange in order to treat ARDS, leading to successful extubation. The author provided support to the patient through giving company, empathy, caring and encouraging the patient to write down his emotions and thoughts to share his feelings. The author also provided timely information to the patient to help him overcome his anxiety. The principle of early goal-directed therapy emphasizes the first 6 hours is the golden period to treat severe sepsis. Such concepts of treatment should be taught via in-service training modalities to save patient lives with severe sepsis within this critical period.

並列關鍵字

Septicemia ； ARDS ； early goal-directed therapy