一位青少年初次罹患原發型自發性氣胸之急診照護經驗

本文主要描述一位19歲青少年初次罹患原發型自發性氣胸於急診之照護經驗。照護期間為2017/12/2208：00至2017/12/2214：40，運用Gordon十一項功能性健康型態評估工具進行整體性評估，藉由身體評估、觀察、訪談及直接照顧等方法收集資料，發現個案有「急性疼痛／與pigtail導管留置有關」、「低效性呼吸型態／與右側肺臟受壓致通氣量減少有關」、「健康尋求行為／與尋求疾病照護及戒菸知識有關」等健康問題。照護期間運用視覺類比量表將疼痛程度量化，提供疼痛自我控制方法、教導移動體位時管路固定的技巧、協助半坐臥舒適臥姿等措施減輕疼痛；三班監測呼吸音及胸腔引流系統狀態以評估肺擴張程度，配合練習正確使用Triflow-Ⅱ強化肺部通氣功能；並給予疾病相關資訊與影像媒體網站增進疾病認知，先提升戒菸意願，再配合5D策略克服煙癮方法維持戒菸的意志力。期望此照護經驗能提升同仁對青少年罹患原發型自發性氣胸患者的警覺心，增加對吸煙史等復發因子之評估，強調吸煙與疾病復發有高關連性，積極介入戒菸措施，並耐心指導氣胸復發症狀及緊急就醫治療之重要性。

關鍵字

青少年；原發型自發性氣胸；急診照護

並列摘要

This article describes the emergency nursing experience of a 19-year-old teenager's first time suffering from primary spontaneous pneumothorax. The nursing period was from 2017/12/21 22 : 22 to 2017/12/22 14：40. We used the Gordon 11 Function Health Patterns to collect data via physical examination, observation, history taking, and primary care. We found the patient had health problems such as ＂pain, related to pig-tail insertion＂, ＂low function respiratory pattern, related to right lung compression＂, and ＂health seeking behavior, related to quitting smoking＂. We used the visual analog scale for pain, and provided the male patient with methods of self pain-control. We taught him the skill of fixing the tube while moving his body, and the comfortable positions to relieve pain. We monitored breathing sounds and the pig-tail drainage to evaluate lung expansion, while teaching him how to use Triflow-II and provided information about the disease, then further enhanced the will for quitting smoking with 5D strategy. We hope this case report can raise our colleagues' alertness to primary pneumothorax and the evaluation of disease recurrence factors such as smoking, by active intervention to encourage quitting smoking, and providing patient guidance for the symptoms of pneumothorax and the importance of seeking medical advice.

並列關鍵字

Teenager ； primary spontaneous pneumothorax ； emergency care

參考文獻

Bobbio, A., Dechartres, A., Bouam, S., Damotte, D., Rabbat, A., Regnard J. F., ... Alifano, M. (2015). Epidemiology of spontaneous pneumotho rax: Gender-related differences. Thorax, 70(7), 653-658. doi:10.1136 /thoraxjnl-2014-206577

Tschopp, J. M., & Marquette, C. H. (2017). Spontaneous pneumothorax: Stop chest tube as first-line therapy. European Respiratiory Journal, 49(4), 1700306. doi: 10.1183/13993003.00306-2017

Winnie, H. O., Rune, L. J., Niels, K., Jesper, E. S., Ingrid, L. T., & Poul, E. A. (2016). Reccurent primary spontaneous pneumothorax is common following chest tube and conservative treatment. World Journal of Surgery, 40(9), 2163-2170. doi:10.1007/s00268-016-3508-z.

王桂芸、李惠玲(2016)．呼吸系統疾病之護理．於劉雪娥總校閱，成人內外科護理(七版，965-1166頁)．台北市：華杏。