- 期刊
- OpenAccess
- Ahead-of-Print
照顧一位重症肌無力併發呼吸衰竭個案脫離呼吸器之加護經驗
Care of a patient with myasthenia gravis combined with respiratory failure to wean from ventilator
摘要
本文是照護一位50歲男性重症肌無力的個案，首次接受氣切手術呼吸訓練脫離呼吸器之加護經驗，護理期間為2019年5月23日至2019年6月9日，應用Gordon十一項健康功能型態為評估工具，以觀察、照護、身體評估及筆談等收集資料，評估發現個案三項護理問題：一、低效性呼吸型態，協助執行肺部復建運動並使用高頻胸壁壓縮機器協助拍痰，教導有效咳嗽技巧，有效將痰液咳出並即早脫離呼吸器；二、營養少於身體所需，提供適當營養支持維持身體營養所需，以減少體重流失及呼吸器使用天數；三、無望感，經醫師解釋治療方針及預後，藉由持續關懷並提供轉移注意力技巧，使個案表達內心感受，以逐漸減輕無望感。加護病房著重在急性期的照護，時常忽略個案除面對疾病所造成的生理不適外，未來無法回歸正常生活也備感擔憂，故建議照護此類個案於急性期提升個案及家屬對疾病之認識及照護能力，提供足夠的營養需求及執行肺部復健運動並鼓勵家屬一同參與，引導個案及家屬表達其感受並給予心理支持，以早期脫離呼吸器，進而改善生活品質。
並列摘要
This article describes the experience of caring for a 50-year-old male with myasthenia gravis in the intensive care unit. He underwent tracheotomy for the first time and performed breathing training for ventilator weaning. The period is from May 23, 2019 to June 9, 2019. We use Gordon's 11 Functional Health Patterns as an assessment tool to collect data for observation, care, physical assessment, and written conversations. The assessment revealed three health problems in the case: (1) Inefficient breathing patterns. We assist in performing lung rehabilitation exercises and use high-frequency chest wall oscillation to assist in taking sputum, teaching cases effective coughing skills, effectively coughing up sputum, and weaning the ventilator early. (2) Malnutrition. We provide appropriate nutritional support to maintain the body's nutritional needs, to reduce the weight loss of the case and the number of days of respirator use. (3) Hopelessness. After the doctor explained the treatment policy and prognosis, the medical staff continued to care and provide attention-shifting skills to enable the case to express inner feelings and gradually reduce the sense of hopelessness. The intensive care unit focuses on care in the acute phase and often ignores the physical discomfort caused by the illness in the case, but also the worry that it will not be able to return to normal life in the future. Therefore, it is recommended that when caring for such cases, the knowledge of the case and family members of the disease and the ability to care for the disease should be improved in the acute phase. Provide adequate nutritional needs and perform lung rehabilitation exercises and encourage family members to participate. Guide the case and family members to express their feelings and provide psychological support to weaning ventilator early and improve the quality of life.