有機磷中毒導致呼吸衰竭病人之護理經驗—個案報告

Nursing Experience of a Patient with Organophosphate Poisoning Induced Respiratory Failure: A Case Report

戴國英(Kuo-Ying Tai) ； 郭巧雯(Chiao-Wen Kuo) ； 黃露萩(Lu-Chiu Huang)

《北市醫學雜誌》 14卷2期 (2017/06) Pp. 199-209

https://doi.org/10.6200/TCMJ.2017.14.2.09

摘要

本篇為照顧一位截肢後服用有機磷中毒導致呼吸衰竭病人之護理經驗，護理期間自2013 年3 月26 日至4 月6 日，以Gordon 十一項健康功能型態為評估架構，利用觀察、溝通、筆談及身體評估等方法收集資料並分析，確立病人的健康問題有：一、呼吸道清除功能失效與呼吸道分泌物增加及無力清除有關；二、組織完整性受損與截肢傷口癒合不良有關；三、潛在性危險性自殺與久病厭世及截肢後心情低落有關。護理期間與團隊共同擬定脫離呼吸器及呼吸肌訓練計畫，並提供高蛋白管灌配方，成功幫助病人脫離呼吸器並拔除氣管內管，透過多媒體工具主動分享傷口癒合狀況，同時轉移注意力緩解換藥時傷口疼痛，提供支持性及保護性環境，協助家屬參與，透過錄製鼓勵的話語主動表達家人的關懷及鼓勵，鼓勵病人說出內心感受，維持正向的互動關係。筆者建議透過社會局建置跨縣市“跨團隊醫療照護資訊平台“連結自殺防治中心資訊，主動提供多重疾病慢性病病人社區居家關懷及心理支持，以期能做到早期自殺防治，避免憾事發生。

關鍵字

呼吸衰竭 ； 截肢 ； 自殺 ； 關懷理論

並列摘要

This paper presents the nursing experience of a patient undergoing amputation who had suffered from respiratory failure after organophosphate poisoning. The nursing care period was from 26th March to 6th April 2013. The Gordon 11 Functional Health Patterns, observations, conversations, sketching and physical examinations were used to collect patient’s data for analysis. The confirmed health problems were: (1) excessive airway secretion related to dysfunction of airway clearance; (2) bad healing of amputation wound related to impaired tissue integrity; (3) potentially suicidal related to long term illness and low mode after amputation. During the nursing care period, the nursing plan included assisting the patient weaning from the mechanical ventilator and conducting muscle training program, and provided high proteins tube feeding formulation. We successfully helped the patient weaning from the ventilator and removed the endotracheal tube; we shared wound healing progress with the patient using multimedia tools, diverted patient’s attention when changing wound dressing to relieve pain, and provided supportive and protective environment; we helped the family members to join making records to express their care and encouragement, and encourage the patient to express feeling inside to maintain positive interaction with the family. The authors suggest establishment of a Cross-team Medical Care Information Platform by the Social Welfare Bureau. Together with the information of the suicide prevention center, the health care units can provide home care and psychological supports for patients with mutiple-chronic diseases to prevent suicide at the early stage.

並列關鍵字

respiratory failure ； amputations ； suicide ； caring theory