- 期刊
照顧一位愛滋病合併肺囊蟲肺炎感染二次插管病人之加護護理經驗
A Nursing Experience of Successful Ventilator Weaning for A Critically Ill Patient with Acquired Immune Deficiency Syndrome Complicated with Pneumocystis Jiroveci Pneumonia
摘要
本文係探討照護一位愛滋病併肺囊蟲肺炎感染致呼吸衰竭，二次插管且成功脫離呼吸器之個案，於2014/09/09～2014/10/25加護護理期間，藉由身體評估、紙筆溝通、會談、觀察家庭互動等方式收集資料，運用Gordon十一項功能性健康評估為護理評估架構進行整體性評估，確立健康問題一、現存性感染；二、呼吸器戒斷反應功能失常；三、身體心像紊亂。以同理心與個案建立治療性關係，經由監測體溫及白血球、病毒量及CD4之變化，立即向醫師反映並依醫囑調整抗愛滋病毒藥物；嚴格遵守無菌技術及感控規範，指導個案及家屬後續健康自我管理，使感染及病情獲得控制。成功的控制呼吸道感染，衛教早期接受氣切手術之益處及具個別性的復健運動，成功幫助個案脫離呼吸器並拔除氣切管；於氣切期間重建並發展正向的調適技巧，使個案能積極面對疾病，重建平衡的身體心像。最終能回歸社會，達自我照顧及健康維護的目的，盼藉此個案的護理經驗分享，能作為其他護理同仁照護之參考。
並列摘要
This paper explored the successful ventilator weaning off of an AIDS patient who presented respiratory failure secondary to PJP infection. During 16 days intensive care, the assessment was conducted through written communication, interview, clinical observation of family interaction and physical examination guided by Gordon 11-item functional health pattern. Health problems identified were 1), potential risk for infection, 2), dysfunctional ventilator weaning response, and 3), body image disturbance. The empathetic approach help establish therapeutical relationship. Interventions controlling infection and underlying disease, that included monitoring of body temperature, white blood cell count, virus load, CD4, and adjustment of anti-AIDS agent. Timely communication to the physician in charge, maintaining strict aseptic and infection control technique, and patient/family teaching on future self-care management were employed. By control of respiratory tract infection, patient education on early tracheostomy and individual rehabilitation, patient was weaned from the ventilator successfully and the tracheostomy tube was removed. The patient also developed positive coping skills and reintegrated the body image during the tracheal reconstruction. Ultimately patient was able to resume normal social integration, perform self-care and health maintenance activities. The author suggests that this case report be used for future references.