腦中風病人併發呼吸器相關肺炎之護理經驗－個案報告

Nursing Experience of a Stroke Patient Complicated with Ventilator-associated Pneumonia: A Case Report

廖愛華(Ai-Hua Liao) ； 郭巧雯(Chiao-Wen Kuo) ； 劉陳愛勤(Ai-Chin Liu Chen) ； 黃露萩(Lu-Chiu Huang)

《北市醫學雜誌》 12卷4期 (2015/12) Pp. 373-384

https://doi.org/10.6200/TCMJ.2015.12.4.10

摘要

本篇敘述一位74歲男性病人因出血性腦中風併發呼吸器相關肺炎之護理經驗。筆者於2012年1月20日至2月24日期間護理期間該個案，運用Gordon十一項健康功能型態評估架構，以身體評估、觀察、筆談、陪伴等技巧收集資料，確立病人的健康問題依序有：一、呼吸道清除功能失效與支氣管分泌物增加、黏液過多有關；二、無力感與對脫離呼吸器訓練缺乏控制力有關；三、照顧者角色緊張與對未來的照護及安置不了解有關。同時，亦經由提供胸腔物理治療、教導深呼吸及咳嗽技巧，並與醫療團隊和病人共同擬定脫離呼吸器訓練計畫，使病人能成功脫離呼吸器拔除氣管內管；另運用Watson關懷理論給予傾聽、陪伴及心理支持，以溝通字卡及圖卡引導病人及主要照顧者表達內在想法與感受，提升病人自我信心，以重回正常生活；教導家屬基本照顧技巧，提供妥適的社會資源，以減輕家屬照顧負荷。根據此個案的護理經驗，發現出院病人往往在心理及社會需求上無整體性規劃，建議能運用遠距醫療概念，建構醫療諮詢教育平台，提供具時效性且立即的醫療服務及照護資源分享，以達全人照護。

關鍵字

腦中風 ； 呼吸器相關肺炎

並列摘要

This article describes our nursing car e experience of a 74-years-old male patient with hemorrhage stroke and ventilator associated pneumonia. The authors took care of the patient from 20 Jan to 24 Feb 2012. During this period, we gathered health information of this patient with the framework of Gordon health functional assessment tool and the clinical techniques including physical examination, bed side observation, pen talk and accompanying. The patient had the following problems: (1) dysfunction of airway clearance related to increased secretion and mucus in the bronchus, (2) fatigue related to less muscle power in ventilator weaning process, and (3) tension of the caregiver related to misconception of further care and destination. The endo-tracheal tube was extubated successfully via the aid of chest physical care, deep breath and cough power training, and planning and implementation of a training program to wean from the ventilator by both the patient and caring team. We followed and practiced the Watson caring theory in our clinical care. We listened, accompanied and provided psychological support to the patient. In addition, we encouraged and taught the patient and his main caregiver by word and graph card approach to expressing actual feeling. These clinical techniques helped build confidence between the patient and his family, and the patient to go back to normal life. We also taught the family basic daily care skills and the use of social resources to relieve care and economic burden. To achieve the goal of holistic health care, we suggests implementing of distance healthcare by constructing a medical counseling and education platform that provides effective medical care services and nursing care resources for discharged patients who require less psychological and social supports.

並列關鍵字

stroke ； ventilator ； pneumonia