照顧一位先天畸型合併呼吸窘迫症候群早產兒及其父母之護理經驗

The Nursing Experience Caring for Premature Infant Diagnosed with Congenital Anomaly and Respiratory Distress Syndrome and His Parents

邱婉婷(Wan-Ting Chiu) ； 池美華(Mei-Hua Chih)

《中山醫學雜誌》 22卷1期 (2011/03) Pp. 83-92

https://doi.org/10.30096/CSMJ.201103.0009

摘要

本文主旨為照顧一位妊娠28週合併有呼吸窘迫症候群之早產兒之護理經驗，案父母因個案罹患開放性動脈導管、唐氏症、左腳膝下肢體缺損等先天畸型，於住院初期簽具拒絕急救同意書。護理期間為2009年7月13日至2009年7月21日，依Gordon十一項功能性健康型態評估進行資料收集及分析。探討個案的健康問題及其合併症，以及案父母所面臨的處境，確立個案問題有：（一）潛在危險性戚染；（二）低效性嬰兒哺餵型態；（三）低效性呼吸型態；（四）成長及發育改變；（五）潛在危險性父母／嬰兒依附關係改變；（六）家庭因應能力失調等六項護理問題。筆者運用發展支持性護理及回歸家庭基本需求，提供關懷及護理照護，加上臨床資源的運用，如安寧共同照護，使案父母以正向態度面對個案先天畸型的事實，進而達到良好的護理品質。筆者藉由此個案報告分享不同以往的護理經驗，內省自身對於生命價值意義之體會，早產兒的小生命，也能帶給我們無限的珍惜，期望護理同仁共勉之。

關鍵字

先天畸型 ； 呼吸窘迫症候群 ； 早產兒 ； 家庭 ； 護理經驗

並列摘要

The purpose of this case report was to explore the nursing experiences of caring an infant with 28 weeks' gestational age and his parents. The premature infant was diagnosed with respiratory distress syndrome, patent ductus arteriosus, Down syndrome, and agenesis below left knee. His parents decided to sign the contract of ”Do not Resuscitate”. The duration of care was from July 13, 2009 to July 21, 2009. The data collection and analysis was based on Gordon 11-item Functional Health Pattern Assessment, which was used to discuss the infants' health problems and complications as well as the problems the parents faced. These included (1) a risk for infection, (2) an ineffective feeding pattern, (3) an ineffective respiration pattern, (4) alteration in growth and development, (5) a risk for altered relationship between parents and infant, and (6) incoordination in the family's ability to cope. The nurses used developmental and supportive nursing skills to provide care in response to family needs. Clinical resources, including palliative care, helped the parents positively face the realities and challenges these congenital conditions presented. It is hoped this report would lead to fellow nurses to reflect on their own life values and cherish the life of a premature infant.

並列關鍵字

congenital deformity ； respiratory distress syndrome ； prematurity ； family ； nursing experiences