一位深頸部感染病患初次接受氣切手術之護理經驗

Nursing Experience of Deep Neck Infection Patients Receiving an Initial Tracheostomy

吳孟蓉(Meng-Jung Wu) ； 黃雅鈴(Ya-Ling Huang)

《若瑟醫護雜誌》 14卷1期 (2020/07) Pp. 47-58

摘要

深頸部感染病人氣切手術常以緊急和非預期方式出現，本文描述一位65歲女性因深頸部感染執行緊急氣切手術面臨身體失能和心理衝擊。照護期間自2016年9月8日至2016年9月16日，運用Gordon十一項功能性健康型態以觀察、筆談、身體評估、病歷查閱等方式收集資料，確立其健康問題為「呼吸道清除功能失效」、「言詞溝通障礙」和「身體心像紊亂」，護理措施包括有效咳嗽、高頻胸壁震盪治療和抽痰，結合跨領域團隊（醫師、呼吸治療師和復健師）；其次設計溝通圖卡表達其生理需求，建立非語言溝通模式；最後釐清對氣切錯誤認知，運用鏡子了解和接受身體結構改變，提供多媒體教學（網路影片、衛教單張、回覆示教和筆試），讓個案和家屬共同學習照護和建立自信心，不只個案恢復健康返家，也讓家庭早日回歸正常生活，臨床氣切手術著重術前評估和風險管理，缺乏術後照護流程，期望藉此分享照護經驗，以提供醫院建立標準作業規範，提供全面和高品質照護。

關鍵字

深頸部感染 ； 氣切 ； 言詞溝通障礙

並列摘要

A tracheostomy for patients with a deep neck infection often takes place in an urgent and unexpected manner. This paper describes a 65-year-old woman with respiratory compression due to a deep neck infection, and the physical dysfunction and mental impact experienced after emergency tracheostomy was performed. The nursing care period was from September 8th to September 16th, 2016. The Gordon’s 11 functional patterns as the assessment framework through observations, written communication, physical assessments, medical record review, etc., data was collected. The main health problems include Ineffective airway clearance, impaired verbal communication, and disturbed body image. The nursing care measures include: impart effective cough, high-frequency chest wall oscillation treatment and sputum suction. The cross-disciplinary teams (physicians, respiratory therapists, and rehabilitation workers) worked together to restore the case's health as soon as possible. Secondly, communication flash cards (including human figures and texts) were designed. Using simple techniques, the physiological needs were expressed, and a non-verbal communication mode was established. Finally, the case was encouraged to express her feelings towards the tracheostomy in order to clarify misconceptions about tracheostomy. A mirror was used for her to understand and accept the changes in body structure, while multimedia teaching methods including online videos, health education leaflets, reply teaching and written tests were provided to enable the case and her family members to jointly learn about tracheostomy wound care and rebuild self-confidence, so as to not only restore the case's health to be discharged and return home, but also ensure the family returns to normal life as soon as possible. Tracheostomy care at present focuses on pre-operative assessment and risk management, but lacks post-operative care procedures. Therefore it is hoped that the experience of nursing care will be shared to recommend the hospitals should establish standard operating procedures to provide comprehensive high-quality care.

並列關鍵字

Deep Neck Infection ； Tracheostomy ； Impaired verbal communication

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