照護一位急性呼吸窘迫症候群患者採俯臥治療之護理經驗

Experience of Using Prone-Positioning Therapy to Care for a Patient with Acute Respiratory Distress Syndrome

陳玉佳(Yu-Chia Chen) ； 楊淑寬(Shu-Kuan Yung) ； 胡蓮珍(Lien-Jen Hwu)

《澄清醫護管理雜誌》 11卷1期 (2015/01) Pp. 64-72

摘要

本報告是描述一位39歲女性，因感冒、肺炎引發急性呼吸衰竭，診斷為急性呼吸窘迫症候群，採俯臥治療之護理經驗。筆者照護期間為2012年2月25日至3月16日，運用Gordon十一項功能性健康評估，歸納出個案有「氣體交換障礙」、「潛在危險性感染」、「潛在危險性皮膚完整性受損」、「焦慮」等健康問題。護理期間運用主動關懷、同理心、陪伴等技巧，與個案及家屬建立良好護病關係，透過醫護聯合討論會，給予全人全隊照護，施以俯臥治療行肺部保護策略維持氧合。成功預防因鎮靜劑使用及俯臥可能產生的皮膚破損並遵守無菌原則預防二度感染。心理部份提供個別性護理，運用傾聽陪伴及衛教，減少因健康狀況受到威脅、環境改變而引發之焦慮。2012年3月16日病情穩定，開始訓練脫離呼吸器，追蹤個案於4月10日成功拔管，4月22日出院返家。

關鍵字

急性呼吸窘迫症候群 ； 俯臥治療 ； 焦慮

並列摘要

This report describes the use of prone-positioning therapy to treat a 39-year-old single woman who was diagnosed with acute respiratory distress syndrome after suffering acute respiratory failure induced by a cold and pneumonia. The author provided care from February 25 to March 16 2012, and employed Gordon's 11-item functional health patterns assessment to determine that the patient had ＂impaired gas exchange,＂ ＂potentially hazardous infection,＂ ＂potentially hazardous impaired skin integrity,＂ and ＂anxiety.＂ The care-giver employed active solicitude, empathy, and companionship during the period of care, and established a good nurse-patient relationship with the patient and family members. The patient was given holistic and team care via doctor-nurse discussion sessions. Prone-positioning therapy and a respirator managed by a respiratory therapist were used to protect the patient's lungs and maintain oxygenation. Potential skin damage caused by the patient's prone position and use of sedatives was successfully prevented, and aseptic principles were used to prevent secondary infections. With regard to psychological care, the care-giver provided individualized care, and used listening, companionship, and health education to reduce the patient's anxiety due to health threats and environmental changes. After her condition was stabilized, the patient begin respirator weaning training on March 16, 2012. Extubation was performed successfully on April 10, 2012, and the patient was discharged and returned home on April 22.

並列關鍵字

Acute respiratory distress syndrome ； Prone-positioning therapy ； Anxiety