照護一位慢性阻塞性肺部疾病個案等候肺移植手術之護理經驗

Nursing Care Experience on a Patient with End-stage Chronic Obstruction Pulmonary Disease Waiting in Line for Lung Transplantation

顏榆庭(Yu-Ting Yen) ； 黃秀霖(Hsiu-Lin Huang) ； 鄒怡真(Yi-Chen Tsou)

《馬偕護理雜誌》 15卷2期 (2021/07) Pp. 35-45

https://doi.org/10.29415/JMKN.202107_15(2).0004

摘要

本文探討一位末期慢性阻塞性肺病（Chronic Obstructive Pulmonary Disease, COPD）等候肺移植手術之個案。護理期間自2018年5月17日至2018年6月19日，採用Gordon十一項功能性健康評估模式，透過直接觀察、身體評估、瀏覽病歷資料、會談、實際照護與家庭互動等方式，進行整體性評估，發現個案有低效性呼吸型態、營養改變少於身體所需及不確定感等健康問題，護理過程中提供正壓呼吸器、教導有效呼吸與運動訓練以緩解呼吸不適，並聯繫氣喘個管師與營養師給予個別性指導；心理方面，則提供肺移植手術之術前準備及術後照護、因應可能出現的合併症、傾聽及關注個案內心感受，並聯繫移植小組定期追蹤，以減少個案內心之不確定感；此外，鼓勵家屬參與護理計畫，使得個案獲得更適切照護，並增加等待移植手術之正向調適。

關鍵字

慢性阻塞性肺部疾病 ； 不確定感 ； 肺移植

並列摘要

This case report described the nursing care experience of a patient with terminal-stage chronic obstruction pulmonary disease (COPD) waiting in line for lung transplantation. The nursing period of care was from May 17 to June 19, 2018. Through direct nursing care, in-depth interviews, observations of family interactions, physical examinations, Gordon's 11 Function Health Patterns for assessments, and retrospective investigation on medical records, major health problems were identified, including: activity intolerance, malnutrition, and uncertainty in illness. During the nursing process, the Bilevel Positive Airway Pressure was provided to relieve breathing discomfort; the patient was taught how to effectively breathe with exercise training in order to enhance activity tolerance. In addition, the patient's asthma educator and nutritionist were referred to provide individualized consultation. Other nursing care included lung transplantation relative information, possible complications responses, active listening and company in order to alleviate feelings of uncertainty, etc. Family members were particularly encouraged to be included in the care for better quality of life. Such individualized care has resulted in patient's alleviated symptoms and a positive attitude toward lung transplantation.

並列關鍵字

chronic obstruction pulmonary disease ； lung transplantation ； activity intolerance ； uncertainty

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