一位COVID-19病人合併急性呼吸衰竭之加護經驗

Experience Caring for a Patient with COVID-19 with Acute Respiratory Failure in the Intensive Care Unit

曹心怡(Hsin-Yi Tsao) ； 莊寶玉(Pao-Yu Chuang) ； 龔淑櫻(Shu-Ing Gone)

《臺大護理雜誌》 17卷2期 (2021/07) Pp. 28-40

https://doi.org/10.6740/NTUHJN.202107_17(2).0004

摘要

本文描述一位中年男性感染COVID-19致呼吸衰竭的護理經驗，因確診為COVID-19入住負壓隔離室，個案有顯著不安情緒，護理期間自2020/3/30-4/5，以觀察、傾聽及身體評估等技巧收集資料，運用Gordon 11項功能性健康型態評估，確定個案健康問題有：低效性呼吸型態、活動無耐力與社交隔離。經由與醫療團隊合作，偕同醫師說明治療方向，降低個案罹患新興傳染疾病的不安及威脅感；即時給予插管，維持足夠氧合濃度，後續協助個案脫離呼吸器；制定復健計畫及漸進式活動，利用多媒體教學影片指導復健活動，改善其活動無耐力問題，亦透過主動關懷，與個案建立信任感，鼓勵表達心中感受，傾聽需求，藉由案女書寫卡片及手機通話方式，提供案妻目前的病況以緩解個案焦慮。建議未來可建置多媒體教學影片，以提升護理指導完整性與成效；若能善用舒壓療癒音樂，緩和重症病人之焦慮及降低護理師因高壓工作的緊張情緒，並適時安排心理師的關懷會談，可以提供重症病人更完善的身心靈照護。

關鍵字

COVID-19 ； 低效性呼吸型態 ； 活動無耐力 ； 社交隔離

並列摘要

This article describes our nursing experience caring for a middle-aged man with a COVID-19 infection complicated with respiratory failure. The patient was significantly disconcerted on being diagnosed with COVID-19 and admitted to a negative-pressure isolation room. The nursing period was from March 30 to April 5, 2020. Gordon's 11 functional health patterns assessment was used to collect data through observation, listening, and physical assessments. An ineffective breathing pattern, activity intolerance, and social isolation were identified as the major health problems. By cooperating with the medical team, treatment goals were communicated with the physicians to reduce the patient's anxiety and sense of threat when confronting an emerging infectious disease. The medical team provided timely intubation to maintain adequate oxygen concentration and assistance to wean the patient off the ventilator. Activity intolerance was improved with progressive exercises, formulating rehabilitation plans via multimedia tutorial videos to guide rehabilitation activities. The medical team established a trust through caring gestures, encouraging emotional expression, and listening to the patient's needs. The patient's anxiety was relieved by writing cards and conducting phone calls to his wife to update her on his medical condition. We recommend developing more multimedia tutorial videos in the future to enhance the completeness and effectiveness of nursing guidance. Future intervention may incorporate music therapy to reduce the anxiety of critically ill patients and nurses owing to the high pressure of the acute care setting. Caring consultations may be arranged with psychologists to provide complete physical and mental care for critical patients.

並列關鍵字

COVID-19 ； ineffective breathing patterns ； physical activity intolerance ； social isolation