一位膿胸合併呼吸衰竭患者及其家屬之加護病房護理經驗

Nursing Experience in an Intensive Care Unit of a Patient with Empyema Complicated with Respiratory Failure and his Family

林筱嵐(Siao-Lan Lin)

《彰化護理》 27卷4期 (2020/12) Pp. 73-85

https://doi.org/10.6647/CN.202012_27(4).0009

摘要

本文敘述一位82歲因膿胸導致呼吸衰竭，需接受非預期胸腔內視鏡輔助手術治療個案之護理經驗。護理期間自2018年6月12至2018年6月30日，以Gordon十一項健康功能型態評估為架構，進行整體性評估及資料分析後，確認主要照護任務為呼吸道清除功能失效、疼痛和照顧者角色緊張之護理問題。本文中個案年事已高且首次面臨多重侵入性管路置入造成身心不適，而個案與家屬因對疾病的不確定感，及多重壓力而引發焦慮、緊張問題。照護期間，藉由專責護理照護方式，適時表達對個案的關懷及同理，建立良好護病關係，使個案及家屬願意分享及抒發內心感受，增加對治療的自信，並透過家庭成員互動，鼓勵家屬參與照護，增強親情支持，並運用資源介紹胸腔鏡手術，藉由引導及陪伴下以減輕焦慮，適時予疼痛控制，促進身體舒適，以利呼吸訓練並成功脫離呼吸器，期望藉由此經驗分享，能提供臨床護理人員照顧此類個案的依據，提升臨床護理人員實務之參考，有助於達到更完善護理品質以減少住院天數。

關鍵字

膿胸 ； 呼吸衰竭 ； 胸腔內視鏡輔助手術

並列摘要

This article describes the nursing experience of an 82-year-old patient with respiratory failure due to empyema, who needs to receive unintended chest endoscopy-assisted surgery. Were ineffective airway clearance、pain and caregiver role strain. The case in this article is very old and for the first time faces multiple physical intrusions that cause physical and mental discomfort, and the case and family members are anxious and nervous due to the uncertainty of the disease and multiple stresses. In the process of nursing,it is important to establish trust with the case and family membres,monitor their physiological changes,and provide adequate psychological support and nursing education,so that the case and family can correctly understand the disease process and self-case methods.Make the case and family members willing to share and express their inner feelings, increase self-confidence in treatment, and encourage family members to interact and encourage Family members participate in care, enhance family support, and use resources to introduce thoracoscopic surgery, reduce anxiety by guidance and companionship, timely pain control, promote physical comfort, facilitate breathing training and successfully get out of the respirator, I hope this experience sharing can be When clinical nurses take care of such cases, improve the quality of care and reduce the number of hospital days.

並列關鍵字

empyema ； respiratory failure ； Video-Assisted Thoracic Surgery ； VATS

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