心臟衰竭病人脫離呼吸器之護理經驗－個案報告

Nursing Experience of Weaning from Ventilator in a Patient with Heart Failure : A Case Report

吳柔萱(Jou-Hsuan Wu) ； 蔡衣帆(Yi-Fan Tsai) ； 陳頌云(Sung-Yun Chen) ； 楊時芳(Shih-Fang Yang) ； 林美玲(Mei-Ling Lin)

《北市醫學雜誌》 15卷1期 (2018/03) Pp. 105-116

https://doi.org/10.6200/TCMJ.201803_15(1).0011

摘要

本篇描述一位64歲女性因接受髖關節置換，術後產生心臟衰竭造成依賴呼吸器，經由護理介入成功脫離呼吸器之經驗。筆者於2016年3月11日至5月30日的照護期間，以Gorden十一項功能性健康型態評估方式，透過直接照顧、觀察、會談的方式收集資料，並確認問題，發現個案有三個主要健康問題:（一）心輸出量減少；（二）呼吸器戒斷反應功能失常；（三）無望感。透過心臟復健運動訓練，幫助增加心肌耐力，改善心輸出量過低；以持續性呼吸訓練方式，配合肺部復健措施，增加肺活量，改善呼吸器戒斷反應功能失常；並採取正向的支持，鼓勵個案表達感受，增進個案自我控制感。個案在5月30日成功脫離呼吸器後減輕疾病症狀及改善無望感之情緒，病情穩定後轉至普 通病房，予後續追蹤並於6月24日轉介出院準備護理師，出院後由呼吸治療師及復健師和居家護理師固定每月4次提供心肺復健運動及居家護理照顧指導。希望藉此護理經驗，提供日後照護此類個案之參考。

關鍵字

心臟衰竭 ； 心臟復健運動 ； 呼吸器戒斷反應功能失常 ； 無望感 ； 肺部復健

並列摘要

This report describes the nursing experience of ventilator weaning of a 64-year-old female patient, who was diagnosed with heart failure after surgery of hip replacement. Nursing care was implemented from March 11 to May 30, 2016. The patient’s health status was assessed by using the Gordon's 11-item health assessment. Data were collected through direct caregiving, observation, communication and chart review. Three major health problems were identified: decreased cardiac output, dysfunctional ventilator weaning response and hopelessness. The author devised cardiac rehabilitation programs (CRP) suitable for improving the patient’s myocardial endurance and cardiac output. Other nursing interventions were implemented, including instructing pulmonary rehabilitation exercises to strengthen respiratory muscle and increase vital capacity, positive support, and assists the patient to express her emotions to promote patient's self-control. The patient was successfully weaned off from the ventilator on May 30, and transferred to general ward on stable condition. The patient was discharged on June 24 from the hospital. Home-based pulmonary rehabilitation and home care were provided for four times a month after discharge by respiratory therapists, physiotherapists and home nurses. Our clinical experience may be referred as a reference for future nursing care of this type of patients.

並列關鍵字

Heart failure ； Cardiac rehabilitation programs (CRP) ； Dysfunctional ventilator weaning response ； Hopelessness ； Pulmonary rehabilitation