協助一位支氣管肺發育不全合併氣切早產兒家庭之出院準備

本文描述協助一位支氣管肺發育不全合併氣切早產兒之出院準備，由於此早產兒接受氣切且須戴呼吸器返家，此情境對整個家庭而言是極大的壓力及衝擊，因此藉由出院準備計畫提升照顧者的知識、技能及強化心理因應，進而使其能執行出院後之早產兒照護及充分應對各種返家適應狀況。護理期間為2019年3月15日至6月19日，藉由臨床實際照護、會談及病歷資料收集等方式，針對個案生理、家庭進行評估，確立個案與家庭主要的健康問題有：氣體交換障礙、營養少於身體所需及照顧者角色緊張，故過程中予以個別化的護理措施：（一）提供胸腔物理治療，適當擺位與提供良好的氧合循環；（二）協助提高熱量，口腔兩頰按摩與刺激非營養性吸吮；（三）協助案父母學習與回覆示教叩擊、抽痰、氣切造口照護、鼻胃管照護等，以及管路滑脫之緊急處置，並鼓勵案父母參與支持團體及妥善利用社會資源，同時適當採取「以家庭為中心」之照護理念，模擬居家環境執行出院準備，指導照顧者知識與技能，進而增進案父母自信心，使個案返家後可以獲得持續照護。臨床照護上建議儘早開始評估家庭成員間的互動關係與支持系統，將其納入照護範圍，提供相關措施及協助，可減輕主要照顧者的壓力，並提升家屬學習意願及自信心，增加早產兒返家後之照護能力，達到家庭為中心之照護品質，期望本照護經驗之分享，可提供護理師日後照護此類病童之參考。

關鍵字

支氣管肺發育不全；早產兒；出院準備；營養少於身體所需；照顧者角色緊張

並列摘要

This article describes the preparation for discharging the family of a premature infant with bronchopulmonary dysplasia and a tracheotomy. Since the patient wearing a ventilator was sent home, which was a stressful and unexpected scenario for the family, discharge preparation was carried out to improve the knowledge, skills, and mental competence of the care provider. The period of nursing care was from March 15 to June 19, 2019. By administering direct nursing care, conducting interviews, and reviewing charts, the nurse continuously assessed the patient's physiological problems and family conditions. The major health problems related to the patient and his family were dysfunctional air exchange, decreased nutrition intake, and caregiver role strain. Individualized nursing care and chest physical therapy were provided. Proper positioning and good oxygenation cycles were performed. Assistance in increasing calories, oral cheek massage and nonnutritive sucking were also provided. The parents were instructed by the ＂demonstrate-and-repeat＂ method in percussion, sputum suction, tracheotomy care, nasogastric tube care, and emergency management for a slipped tube. Family-centered care concepts were adopted. Therefore, simulating the home environment and enhancing the self-confidence of the parents during discharge preparation resulted in improved outcomes of home care. The patient's parents were also encouraged to participate in support groups and to seek related social resources after discharge. It is hoped that through the sharing of this nursing experience, it could become a reference for clinical nursing care of such cases in the future.

並列關鍵字

bronchopulmonary dysplasia ； premature infants ； discharge preparation ； decreased nutrition intake ； caregiver role strain

國際替代計量

協助一位支氣管肺發育不全合併氣切早產兒家庭之出院準備

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