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

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

徐淑芬(Shu-Fen Hsu) ； 黃秀梨(Shiow-Li Hwang)

《馬偕護理雜誌》 6卷2期 (2012/07) Pp. 59-69

https://doi.org/10.29415/JMKN.201207_6(2).0006

摘要

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）具高度不確定性及不可逆之特性，伴隨著高危險因子誘發反覆發作、急性惡化、就醫頻繁嚴重影響病人及家屬生活品質。本文探討一位上呼吸道感染，導致慢性阻塞性肺疾病合併呼吸衰竭入住加護病房患者的照護經驗。個案家人有COPD治療失敗經驗，對疾病進展有著高度不確定感。護理期間自2010年5月19日至28日，運用Roy's適應模式進行全面性健康評估，確立個案護理問題包括低效性呼吸型態／與換氣量不足及感染有關、體液容積缺失／與腹瀉有關以及焦慮／與疾病急性惡化、呼吸訓練失敗、過去相似經驗有關。透過關懷及全人照護，病人及家屬肯定護理專業而產生信任感，經由提供正確胸腔照護技巧、家屬參與呼吸復原運動、共同規劃出院後持續照護計畫，使病人獲得身心靈完整之照護，家屬亦獲得疾病相關照護知識與技巧，確實提供具個別性、連續性慢性阻塞性肺疾病病人完整照護計畫。

關鍵字

慢性阻塞性肺疾病 ； 呼吸衰竭 ； 加護病房照護經驗

並列摘要

The characteristics of chronic obstructive pulmonary disease (COPD) are highly uncertain and irreversible. The quality of patient's and family member's life is affected by the recurrent attack causing by high dangerous factors, acute exacerbation, being frequent hospitalized. A COPD patient who suffered from upper respiratory infection with acute respiratory failure admitted in intensive care unit. This patient and his families have the failed experience of COPD treatment. The author (the primary nurse) was responsible for this patient for 12 days. Roy's adaptation model was used on comprehensive health assessment. The individual nursing problems included ineffective breathing pattern, fluid volume deficit and anxiety. Through the correct chest care technique, family members could participate the patient's breathing exercise and planned the discharge project together. Patient received a holistic care of body and soul, and family gained the disease-related care knowledge and technique.

並列關鍵字

Chronic obstructive pulmonary disease ； respiratory failure ； experience of intensive care