照護一位鼻咽癌個案面臨氣切之加護經驗

本文旨在描述一位中年男性鼻咽癌個案罹患肺炎併發呼吸衰竭插管入住加護病房治療後，因脫離呼吸器失敗面臨氣切決策之護理經驗。照護期間為2019年12月4日至24日，運用生理、心理、社會與靈性等四大層面評估工具，並藉由直接觀察、身體評估、傾聽、關懷、溝通及查閱病歷收集資料，確立個案有低效性呼吸型態、抉擇衝突及無望感之健康問題。照護期間介入心肺復健促進肺部擴張，強化呼吸肌力，改善肺炎後，仍脫離呼吸器失敗兩次，面臨氣切與否決策，醫療團隊陪伴個案、家屬召開醫病共享決策會議之歷程，使個案能以正向態度自主決策面對氣切，然而面對氣切後無法說話的無望感，提供心理支持並與個案共同討論建立未來新目標，協助個案脫離呼吸器轉至普通病房。藉由此照護經驗做為臨床護理人員未來照護類似疾病的參考。

關鍵字

鼻咽癌；呼吸器脫離困難；醫病共享決策；無望感

並列摘要

This article describes the nursing experience of caring for a middle-aged man who was admitted to the intensive care unit for nasopharyngeal carcinoma complicated by pneumonia and respiratory failure. The nursing period was from December 4-24, 2019. Four main tools were used for assessments in the physical, psychological, social and spiritual aspects. Data collecting was done through direct observation, physical evaluation, listening, nursing care, communication, and medical records. The identified health problems were related to inefficient breathing patterns, choice conflicts, and despair. During the nursing care process, cardiopulmonary rehabilitation intervention was carried out to promote lung expansion, strengthen respiratory muscles, and to treat pneumonia, but the ventilator weaning failed twice. The medical team held a decision-making meeting for the patient with the participation of the family so that the patient can face the trachea with a positive attitude. Providing psychological support and educating the patient on the hopeful new goals of transferring to the ward from the ICU are essential in the weaning process. Finally, the patient successfully weaned from the ventilator and transferred to the ward. This kind of nursing experience can be used as a reference to help the clinical nurses with similar cases in the future.

並列關鍵字

nasopharyngeal cancer ； respirator out of difficulty ； medical disease sharing decision-making ； sense of hopeless

參考文獻

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