新型冠狀病毒（COVID-19）引發嚴重呼吸衰竭病人之護理經驗

本文探討一位確診新型冠狀病毒引發嚴重呼吸衰竭病人之護理經驗。因嚴重肺炎致使病情輾轉直下，造成生、心理相互衝擊之護理過程。照護期間自2020年3月27日至4月27日，經由觀察、直接照護、會談及身體評估等方式進行收集資料，依據生理、心理、社會和靈性層面評估，確認病人的健康問題為：低效性呼吸型態、潛在性高危險性感染和無望感。病人因先生而染疫，被迫置入氣管內管併呼吸器使用，肺部浸潤嚴重，出現呼吸困難、胸部不適，醫療處置上，經指引建議予奎寧及抗生素治療，除此之外，依防護標準流程及儘早評估侵入性導管的留置天數，減輕病人染疫壓力，避免加重感染風險，並運用胸腔復健技巧，促使肺部擴張，緩解呼吸窘迫徵象，進而提升病人面對疾病的復原力。同時病人面對未知的新興傳染病毫無頭緒，更無法看見預後產生無望感，瀕臨生死一線之差，透過跨團隊合作和全人照護，讓病人病情逐漸穩定，成功拔除氣管內管，回歸原有生活。期望藉此分享照護經驗，讓醫護人員在疫情爆發初期有所依循，以儘早訂定相關的照護準則。

關鍵字

新型冠狀病毒；肺炎；隔離；無望感

並列摘要

This article discusses the nursing experience of a patient with severe respiratory failure caused by a confirmed novel coronavirus. Severe pneumonia caused the patient's condition to rapidly decline and the nursing process had mutual impact on health and psychology. During the care period from March 27 to April 27 in 2020, by observation, direct care, interviews, and physical assessment, Gordon's 11 functional health patterns assessment was used. The problems presented by the patient were risk for infection, ineffective breathing pattern and hopelessness. Originally infected by the husband, she was forced to have an endotracheal tube inserted and use a respirator, with her lungs being severely infiltrated, experiencing breathing difficulties, chest discomfort, and attendant medical treatment. Quinine and antibiotics were recommended by the guidelines. Additionally, indwelling days of the invasive catheter were evaluated as rapidly as possible in accordance with the standard protection process to reduce severity of the patient's infection, avoid aggravating the infection further, and use chest rehabilitation techniques to promote expansion of the lungs while relieving signs of respiratory distress thereby improving the patient's ability to face the disease with resilience. At the same time, the patient was unaware about these emergent infectious diseases, and could not see beyond the prognosis of hopelessness, being on the verge of life and death. Accordingly, through cross-team cooperation and whole-person care, the condition of the patient gradually stabilized, the endotracheal tube was successfully removed, and she returned to her original healthy condition. It is hoped that this sharing of the care experience will allow medical staff to transition through the early stages of the epidemic so as to formulate relevant care guidelines as expediently as possible.

並列關鍵字

COVID-19 ； Pneumonia ； Isolation ； Hopelessness

參考文獻

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新型冠狀病毒（COVID-19）引發嚴重呼吸衰竭病人之護理經驗

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