照顧一位使用體外循環維生系統病人之加護經驗

The Nursing Care Experience of Patient with Extrcorporeal Membrane Oxygenation in the Medical Intensive Care Unit

鍾凱吉(Kai-Chi Chung) ； 張瓈方(Li-Fang Chang) ； 洪瑞遠(Jui-Yuan Hung)

《源遠護理》 7卷2期 (2013/11) Pp. 63-72

https://doi.org/10.6530/YYN.2013.7(2).09

摘要

本篇協助一位一氧化碳中毒合併急性呼吸窘迫症候群病人，接受體外循環維生系統治療之重症加護護理經驗。護理期間自2011年2月10日至3月3日，藉由實際參與照顧，運用觀察、同理心、溝通技巧、整體性評估等方式收集資料，針對生理、心理、靈性、社會四大方面進行分析，確立個案主要健康問題有：氣體交換障礙、潛在危險性出血及潛在危險性感染之護理問題，另家屬主要照顧者在面對疾病治療和結果無法預期而產生焦慮的問題。在護理過程中提供整體的護理照護措施，使得病人在使用體外循環維生系統期間，沒有發生嚴重的併發症，最後順利脫離體外循環維生系統。對於無法預期疾病治療和結果感到焦慮的家屬，則透過溝通協調，提供相關醫療資訊，主動告知病情狀況，教導基本照護方法，鼓勵案夫共同參與照顧，並准許彈性會客，以減輕其疑惑改善焦慮不安的情緒。期望藉由此次照護經驗，能提供臨床護理人員照護此類病人和家屬時之參考，提供更完整的照護。

關鍵字

急性呼吸窘迫症候群 ； 體外循環維生系統 ； 氣體交換障礙 ； 潛在危險性出血 ； 潛在危險性感染 ； 焦慮

並列摘要

This article discusses the critical nursing experience of a patient and the primary caregiver over a period of three weeks. The patient received extracorporeal membrane oxygenation (ECMO) treatment for carbon monoxide intoxication and experienced treatment induced acute respiratory distress syndrome. Assessment of the patient's physical, psychological, social and spiritual status was completed through observation, assessment, interview, and written communication. Major health problems of both the patient and the caregiver included, (1) impaired gas exchange, (2) risk for bleeding, (3) risk for infection, and (4) caregiver's anxiety. Treatment goals included prevention of complications and successful weaning of the ECMO system. Provided were communication, coordinated care, information and status update, and teaching caregiver how to participate in care to reduce a sense of uncertainty and anxiety. Verbal and non-verbal communications, empathy, and emotional support helped to reduce the caregiver's anxiety and a holistic approach addressed the patient's spiritual needs.

並列關鍵字

Acute respiratory distress syndrome ； extracorporeal membrane oxygenation ； impaired gas exchange ； risk for bleeding ； risk for infection ； anxiety