運用發展性照護護理一位三十週早產兒之照護經驗

Developmental Nursing Care for a Premature Infant Born at 30 Weeks

張淑鈴(Su-Ling Chang)

《馬偕護理雜誌》 2卷1期 (2008/01) Pp. 70-80

摘要

本文旨在呈現照護一位三十週，體重一千三百五十公克的早產兒，面臨生理功能各方面尚未成熟之護理經驗，此個案於出生後便住進新生兒加護病房。筆者自2005年10月14日至2005年11月24日期擔任主護護士期間，經由直接照護、行為觀察、身體評估及平時與父母的會談中，評估此個案的確立護理問題有：一、混亂性嬰兒行為；二、低效性嬰兒哺餵型態；三、潛在危險性父母－嬰兒／小孩依附關係改變／早產兒＋分離使父母無法有效的接觸。護理期間以發展性照護為基礎，個案行為表現逐漸趨於統整化；一天睡眠最長時間可達120至160分鐘，清醒時除了執行醫療處置或護理活動時，會出現哭鬧不安之情形，但安撫後也能較快恢復平穩的生命徵象並入睡，每餐亦可於15至20分鐘內將奶瓶內的奶自吸吞食完；並且提供父母正確知識，幫助熟悉個案所出現之行為反應，減輕父母焦慮不安的情緒，增進親子間依附關係建立。

關鍵字

發展性照護 ； 早產兒 ； 護理

並列摘要

A preterm infant (gestational age 30 weeks) with a birth weight of 1350 grams was admitted at the Neonatal Intensive Care Unit immediately after birth and had immaturity of various physical functions. The primary caregiver for this infant for approximately 6 weeks listed the following nursing problems, determined by direct observation of behavior and response, physical evaluation, and interviews with the child's parents: 1) disorganized infant behavior, 2) ineffective infant feeding pattern, 3) risk of poor attachment to and poor interaction with parents because of separation. The nursing plan was based on developmental care. The infant's outcomes included less erratic behavior, maximum sleep periods of 120 to 160 min a day, and reduced irritability except during medical or nursing interventions but after which the vital signs rapidly stabilized with comforting. The infant completed every milk feed within 15 to 20 min. The parents were simultaneously provided with an understanding of their child's behavioral reactions and assisted in developing proper attachment. This reduced their anxiety and enhanced bonding with the child.

並列關鍵字

developmental care ； premature infant ； nursing care