照顧罹患皮肌炎合併呼吸衰竭病人之加護經驗

本文敘述照護罹患皮肌炎且因呼吸衰竭放置氣管內管後轉入加護病房個案的護理經驗。於2014年3月9日至4月7日照護期間藉觀察、會談及直接照顧，採Gordon 11項功能性健康型態進行評估，確立個案有低效性呼吸型態、身體活動功能障礙、知識缺失、無望感之健康問題。經由主動關懷與個案及家屬建立良好護病關係；教導復健運動以改善呼吸狀況、避免肌肉萎縮；向家屬澄清日常照護步驟，並在面臨氣切抉擇時予護理指導及術前說明；以同理心傾聽，持續給予正向回饋並鼓勵表達想法，使個案轉換抑鬱心情，減輕疾病造成的失能與無望感。皮肌炎是無法治癒的罕見疾病，個案家屬的心態調整與居家照護能力為護理重要目標，除護理指導外，亦要給予個案及家屬心理社會支持與靈性照顧，與跨領域專業共同照護個案，使他們能順利銜接後續長期照護。

關鍵字

皮肌炎；呼吸衰竭；無望感

並列摘要

This article described the nursing care experience of a patient with dermatomyositis, who was transferred to the intensive care unit after receiving an endotracheal intubation for respiratory failure. The period of nursing care was from 9 March to 7 April 2014. Based on Gordon's 11 Functional Health Patterns, the nurse assessed the patient's problems by taking observations, conducting interviews, and administering direct nursing care. The patient's health problems were ineffective breathing pattern, impaired physical mobility, knowledge deficit, and hopelessness. The good nursing-patient therapeutic relationship was established by the nurse's active caring behaviors. Nursing education included rehabilitative exercises to enhance the patient's respiratory pattern and preventing patient from muscle atrophy. It also included educating the caregiver about the skills of daily care, and the pre-operation and tracheostomy, to ease the caregiver's decision-making process. The nurse provided empathy, continuingly encouraging the patient to express his feelings and giving him positive responses. Nursing care improved the patient's negative emotions and hopelessness, and his sense of disability due to the long-term illness. Given dermatomyositis is a rare disease, enhancing the positive attitudes toward illness and providing home care skills are the main focus of the nursing cares. In addition to nursing education, nursing care needs to include the psychosocial support and spiritual care for the patients and their families. Finally, with multi-discipline team care, the patients can successfully receive the long-term care after hospital discharge.

並列關鍵字

dermatomyositis ； respiratory failure ； hopelessness

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照顧罹患皮肌炎合併呼吸衰竭病人之加護經驗

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