照護一位極低出生體重合併食道閉鎖早產兒及其家屬之護理經驗

Nursing Experience of Caring for Extremely Low Birth Weight Combined with Esophageal Atresia Preterm in an Infant and His Family

張詩珮(Shih-Pei Chang) ； 范圭玲(Guei-Ling Fann) ； 陳玉蓮(Yu-Lien Chen)

《臺大護理雜誌》 16卷1期 (2020/01) Pp. 39-50

https://doi.org/10.6740/NTUHJN.202001_16(1).0005

摘要

本文描述照護一位極低出生體重早產兒合併食道閉鎖及其家屬之護理經驗。於2018年4月23日至2018年5月10日主護護理期間運用觀察、身體評估及與案父母會談等方式收集個案資料，以整體性評估進行資料收集，確立其健康問題有：（1）潛在危險性肺吸入／與食道閉鎖有關；（2）皮膚完整性受損／與早產皮膚不成熟、術後傷口有關；（3）照顧者角色緊張／與親子分離、對病情進展及醫療資訊不足有關等。護理過程中，除給予個案生理上的照護外，針對案父母面臨雙胞胎皆為極低出生體重早產兒、且個案尚合併食道閉鎖等對未來不確定性之壓力，運用溝通會談及觀察技巧，評估其壓力因應取向，採取以家庭為中心的整體性照護，提供各項親職功能介入措施，配合早產兒發展性照護之需求，舒緩案父母之壓力與緊張情緒，使親職角色逐漸完善，在面對早產病嬰所需較長的生長回復與追趕期，期能發揮最大的親職功能。藉由分享本照護經驗，提供新生兒護理人員在日後相似案例上得以運用及參考。

關鍵字

極低出生體重早產兒 ； 食道閉鎖 ； 親職壓力

並列摘要

This article describes a nursing experience of caring for an extremely low birth weight preterm infant with esophageal atresia. The care period ran from April 23th to May 10th, 2018. The data were collected by systematic physical examination, practical clinical care, and interviews, which revealed three major problems: (1) risk of aspiration; (2) impaired skin integrity; and (3) caregiver role stain. The parents were experiencing uncertainty about the future and a stress due to the extremely low birth weight of twin babies, and the case was combined with esophageal atresia. In addition to providing physical care for the infant, we also adopted the family-centered model to assess the parents' stress reaction, copying skills, and parental functions. We applied interventions for developmental care for the preterm-infant to help the parents release stress and perform their parental functions in the longer recovery and growth period. Sharing the caring experience provided the clinical staff with an increased understanding of the case and will serve as a reference for such cases in the future.

並列關鍵字

extremely low birth weight ； esophageal atresia ； parenting stress