一位重症肌無力併發呼吸衰竭成功脫離呼吸器病患之加護經驗

Nursing Experience of Weaning the Ventilator for a Critically Illed Patient with Respiratory Failure Because of Myasthenia Gravis

陳姵如(Pei-Lu Chen) ； 周怡伶(Yi-Ling Chou) ； 林珈而(Chia-Erh Lin)

《安泰醫護雜誌》 25卷1期 (2019/06) Pp. 61-79

摘要

本文主要探討一位因重症肌無力併發呼吸衰竭病患脫離呼吸器的護理經驗。護理期間自2016年12月20日至2017年01月06日，運用Gordon十一項進行功能性健康評估，歸納出主要護理問題為低效性呼吸型態、睡眠型態紊亂及焦慮。透過互信的護病關係，經由提供教導個案深呼吸、咳嗽技巧及胸腔復健運動，強化呼吸肌功能。夜間採集中護理，維持舒適並營造熟悉睡眠環境，提升睡眠品質，引導個案表達內心其感受，以釐清焦慮來源，降低疾病的不確定感，進而有效地脫離呼吸器，協助病患面對疾病進展的調適，達到身心靈的全人照護。期望藉此護理經驗分享，提供護理人員日後臨床照護此類個案之參考，並重視其生心理各層面需求的調適，以達完整性的照護品質。

關鍵字

重症肌無力 ； 呼吸衰竭 ； 呼吸脫離

並列摘要

This article described a nursing care of a critically illed patient with respiratory failure because of myasthenia gravis. The nursing care period was from December 20, 2016 to January 06, 2017. With Gordon's 11 Functional Health Patterns assessment, the nursing-related problems were identifited as inefficient breathing patterns, sleep disorder and anxiety. The nurse-patient relationship enables the author to teach deep breathing, coughing exercises, pulmonary rehabilitation and improved respiratory muscle function. Furthermore, centralized care management during night shifted was used to arrange comfortable and familiar sleeping environment to improve the patient's sleep quality. The author guided the patient through expressing the authentic feelings to clarify the source of anxiety, to reduce the uncertainty of disease and then weaned from ventilator successfully. We helped the paitent face the adaptation of disease progression, to achieve the holistic care of body-mind-spirit. This experience provided nursing staff with a reference for caring similar patients in the future and drew our attention to the patient's adaptation of psychosomatic need and then increased the integrity of care quality.

並列關鍵字

myasthenia gravis ； respiratory failure ； ventilator weaning