- 期刊
一位肺炎合併急性呼吸衰竭個案之照護經驗
Nursing Experience of a Case with Acute Respiratory Failure Induced by Pneumonia
摘要
本文描述一位因肺炎引起急性呼吸衰竭初次放置氣管內管之照護經驗。個案由於困難呼吸而被緊急放置氣管內管因而失去語言溝通能力，並於第一次拔管失敗後再度插管，在呼吸器脫離自主訓練過程中，出現呼吸困難和害怕失敗拔管的焦慮不安情緒，引起筆者照護動機。照護期間為2019年3月20日至4月4日，經由病歷收集、身體評估、觀察、筆談和會談方式收集資，運用Gordon十一項健康功能性型態進行評估，確立呼吸道清除功能失效、呼吸器戒斷反應功能失常和焦慮健康問題。經文獻探討於照護上，提供胸腔物理治療措施改善氧合狀態；肺部復健強化呼吸擴張與咳嗽技巧利痰液排出；運用團隊合作與其共同參與呼吸器脫離計畫；經由傾聽建立良好護病關係，與陪伴等支持力量減輕生、心理壓力及焦慮，協助個案順利脫離呼吸器；並在後續提供戒菸相關資訊，以達完善之護理。希望藉此經驗，能提供護理人員日後照護相關個案之參考。
並列摘要
This article describes the nursing care experience of a patient with pneumonia related acute respiratory failure. Patient received emergent intubation because of difficult breathing. The first attempt of extubation failed and the patient was intubated again. The patient experienced difficult breathing and anxiety from failed mechanical ventilation weaning process. Associated data were collected through observation, conversation and physical assessment between March 20th and April 4th, 2019. Gordon's 11 health function assessment identified patient problems included ineffective airway clearance, difficulty weaning from mechanical ventilation and anxiety. Evidence-based nursing interventions included chest physiotherapy to improve oxygenation, pulmonary rehabilitation for lung expansion and teamwork to involve the patient and family to participate the weaning protocol. The care team attenuated psychophysiological stress by listening, accompanying and encouragement. Continuous care should include provision of smoke cessation program to achieve optimal outcome. Our experience may be as a reference for future clinical care.