一位慢性阻塞肺疾病合併呼吸衰竭之加護病房照護經驗

Intensive Nursing Experience for a Patient with Chronic Obstructive Pulmonary Disease Coexisted with Respiratory Failure

陳佳德(Chia-Te Chen) ； 張靜芬(Ching-Fen Chang) ； 李靜枝(Ching-Chih Lee)

《彰化護理》 23卷2期 (2016/06) Pp. 50-61

https://doi.org/10.6647/CN.23.02.12

摘要

本文探討位罹患慢性阻塞肺疾病之個案，初次急性惡化而放置氣管內管，轉至加護病房照舊之護理經驗，護理期間自2014年8月2日至2014年8月12日，採用Gordon十一項健康功能型態進行護理評估，經由會談、觀察、身體評估及病歷查閱等方式收集健康資料，確診個案有低效性呼吸型態、焦慮及皮膚完整性受損等健康問題。照護期間密切監測病況進展，給予身體照舊、關懷、傾聽、心理支持，運用同理心建立治療性人際關係：藉簡易文字、圖卡進行溝通，成功安撫焦慮的情緒，自此個案能配合治療：提供疾病相關知識及正確的胸腔照護技巧，與家屬共同擬訂照護計畫，確實執行個別性護理措施後，成功移除氣管內管並轉至普通病房持續照護。

關鍵字

慢性阻塞性肺疾病 ； 低效性呼吸型態 ； 潛在皮膚完整性受損 ； 焦慮

並列摘要

This paper explored an intensive care nursing experience with a patient suffering from obstructive pulmonary disease (COPD) and first time intubation treatment. The nursing period was from August 8 to 12, 2014. Gardon's 11 Functional Health Patterns Assessment was used as a tool for nursing assessment. The data were collected through interview, observation, physical examination and review of medical records. The identified major healthcare problems were ineffective breathing pattern, anxiety and risk of impaired skin integrity. During the period of intensive care unit, monitored condition progresses, provided physical care, caring, listening, and mental support, Applied empathy skill created trust nursing relationship from patient. Patient cannot speech and follow treatment because endotracheal intubation, the author successfully helped communication and diminished anxiety by small simple word and picture cards. Through the individualized planned-nursing care, nurse could collaborate with family members by pulmonary physical therapy that could successful weaning ventilator and transfer to the ward continue care.

並列關鍵字

chronic obstructive pulmonary disease ； ineffective breathing pattern ； anxiety ； risk of impaired skin integrity

參考文獻

徐淑芬、黃秀梨（2012）．一位慢性阻塞性肺疾病合併呼吸衰竭病人之重症照護經驗．馬偕護理雜誌，6(2)，59-69。

陳慧雯、李雅欣、王桂芸（2011）．慢性阻塞性肺疾病病人「低效性呼吸型態」之護理．護理雜誌， 58(5)，95-100。 doi: 10.6224/JN.58.5.95

陳妮婉、張彩秀、張素惠(2013)．護理人員壓瘡預防行為之系統性文獻查證．澄清醫護管理雜誌，9 (2)，40-47。

Cai, B., Zhu, Y., Ma, Y., Xu, Z., Zao, Y., Wang, J., et al. (2003).Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition, 19(3), 229-232. doi: 10.1016/S0899-9007(02)01064-X

Chen, C. J., Lin, C. J., Tzeng, Y. L., & Hsu, L. N. (2009). Successful mechanical ventilation weaning experiences at respiratory care centers. The Journal of Nursing Research, 17(2), 93-101. doi: 10.1097/JNR.0b013e3181a6a601