一位慢性阻塞性肺疾病重症個案之加護經驗

An Intensive Care Experience with a Patient Suffering from Chronic Obstructive Pulmonary Disease

謝媗亘(Hsuan-Hen Hsieh) ； 洪世欣(Shih-Hsin Hung) ； 廖淑貞(Shu-Chen Liao)

《榮總護理》 30卷4期 (2013/12) Pp. 347-354

https://doi.org/10.6142/VGHN.30.4.347

摘要

本文描述一位慢性阻塞性肺疾病重症個案初次插管治療及成功脫離呼吸器的加護經驗。護理期間自2012年1月29日至2012年2月16日，以Gordon十一項健康功能評估為架構，於護理過程中運用身體評估、會談、病歷查閱等方式收集資料，歸納分析個案有氣體交換障礙、活動無耐力、焦慮及因應能力缺失等健康問題。筆者擬定個別性護理計劃，協同醫療團隊、個案及家屬參與漸進式呼吸訓練及活動力促進方案，輔以跨團隊完整性照護計畫，進而成功脫離呼吸器；適時介入疾病衛教及出院準備服務，透過居家呼吸照護資訊及社會資源的運用鼓勵家屬參與照護，增加個案自我照護能力，使個案能有連續性整體的醫療照顧，以達到全人護理。

關鍵字

慢性阻塞性肺疾病 ； 脫離呼吸器

並列摘要

This paper described an intensive care nursing experience with a patient suffering from obstructive pulmonary disease with severe cases of initial intubation treatment. This patient was successfully removed from the breathing apparatus. The nursing care period was from January 29th to February 16th in 2012. Data was collected under the frame of ”Gordon's 11-item Functional Health Status” together with physical examination, interviews and daily nursing care. We found that the patient had problems including gas exchange barrier, activity intolerance, anxiety and a lack of response capacity. In collaboration with the case, the medical team and the family participated in the progressive breathing exercises and activities to promote the program, and had a complete care plans with different teams. Therefore, the patients would eventually be relieved from the breathing apparatus and released from the hospital by in-home respiratory care and community resources. We encourage the family to participate in increasing self-help ability of the patient in order to help the patient receive a complete nursing process.

並列關鍵字

chronic obstruction pulmonary disease ； weaning ventilator

參考文獻

郭文隆、顏兆熊(2010)．慢性阻塞性肺疾病 的臨床表現與診斷．家庭醫學與基層醫 療．25 (5)，171-174。

吳英旬、曾月霞(2009)．呼吸器居家病人家屬照護者之生活經驗．長期照護雜誌， 13 (2)，169-188。

陳慧文、李雅欣、王桂芸(2011)．慢性阻塞 性肺疾病病人低效性呼吸型態之護理． 護理雜誌，58 (5)，95-100。doi:10.6224/ JN.58.5.95

Gimenez, A. M., Serrano, P., & Marin, B. (2008). Clinical validation of dysfunctional ventilatory weaning response:The spanish experience. International Journal of Nursing Terminologies and Classification , 14(2), 53-64. doi:10.1111/j.1744-618X.2003. tb00060.x

Malkoc, M., Karadibak, D., & Yildirim, Y. (2009). The effect of physiotherapy on ventilator dependency and the length of stay in an intensive care unit. International Journal of Rehabilitation Research, 32(1), 85-88. doi:10.1097/MRR.0b013e3282fc0fce