一位肺泡蛋白質沉著症病人以體外維生循環系統行全肺灌洗術之加護護理經驗

The Intensive Nursing Care Experience of Pulmonary Alveolar Proteinosis with Extracorporeal Membrane Oxygenation Support for Whole Lung Lavage

汪欣潔(Shin-Jie Wang) ； 黃秀英(Hsiu-Ying Huang) ； 王麒嘉(Qi-Jia Wang)

《志為護理-慈濟護理雜誌》 21卷5期 (2022/10) Pp. 105-114

摘要

本文描述一位壯年男性因肺泡蛋白質沉著症導致呼吸困難，緊急放置氣管內管輔用體外維生循環系統，完成全肺灌洗術之加護護理經驗。護理期間為2019年4月17日至5月6日，筆者運用Gordon十一項健康功能性評估，藉筆談、會談、病歷查閱、觀察及身體評估等收集資料，確立有氣體交換障礙、妥協性家庭因應能力失調、焦慮等問題。照護過程密切監測氧合功能，早期介入復健改善呼吸功能；提供疾病訊息，給予心理關懷，彈性會客緩解焦慮；召開家庭會議，引導家屬說出感受重建家庭關係，獲得足夠支持系統。期望藉此經驗分享，提供臨床照護參考。

關鍵字

肺泡蛋白質沉著症 ； 全肺灌洗術 ； 體外維生循環系統

並列摘要

This article describes a mature man with dyspnea due to Pulmonary alveolar proteinosis (PAP), that required urgent placement of an endotracheal tube and the extracorporeal membrane oxygenation (ECMO) to provide cardiopulmonary support for complete course of whole lung lavage. The period of nursing care was from April 17 to May 6, 2019. The author collected information by written interviews, interviews, medical record review, observation, physical assessment and use of Gordon's 11 health functional assessments. The patient's health problems were: impaired gas exchange, compromised ineffective family coping, and anxiety. During the nursing process, oxygenation function was closely monitored for successfully weaning the ECMO. Then, early intervention in rehabilitation therapy was used to improve the respiratory function. When facing the anxiety of patient, we provided disease-related information, accompanying to give psychological care, and flexible visiting to relieve anxiety. In addition, we held family meetings to help the patient's family to express their feelings, rebuilt family relationships and established adequate supports. This care experience can be shared as a reference in clinical practice.

並列關鍵字

extracorporeal membrane oxygenation ； pulmonary alveolar proteinosis ； whole lung lavage

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