腹部手術後病人面臨呼吸窘迫症候群之加護經驗

Patient Experience in Respiratory Distress Syndrome After Abdominal Surgery

陳碧鳳(Pi-Feng Chen) ； 楊淑溫(Shu-WenYang)

《彰化護理》 26卷2期 (2019/06) Pp. 27-41

https://doi.org/10.6647/CN.201906_26(2).0006

摘要

本文旨在描述一位腹部手術後病人面臨呼吸窘迫症候群之加護經驗，護理期間自2014年7月3日至7月18日，筆者藉由臨床照護、身體評估、查閱病歷、與個案筆談和主要照顧者會談等方式收集資料，並運用Maslow人類需求理論，進行整體評估與分析，歸納主要護理問題：急性疼痛、呼吸機戒斷反應功能異常、組織完整性受損及焦慮。護理照護期間建立良好護病關係與信任感，先讓個案認識身上的管路及周遭醫療儀器，再讓個案接受它們存在的必要性，接著帶領個案及家屬共同參於呼吸訓練及傷口照護過程，藉由家屬支持、醫療團隊介入、提供適量止痛劑及鎮靜劑，能改善焦慮、促進傷口癒合，使個案順利渡過急性呼吸窘迫症候群造成生、心理失衡，最後成功脫離呼吸器。建議製作胸腔復健及呼吸訓練團體衛教短片，播放於家屬休息室，促進家屬共同參於訓練過程。期許本文的護理經驗分享，提供類案照護之參考。

關鍵字

呼吸窘迫症候群 ； 急性疼痛 ； 傷口照護 ； 焦慮

並列摘要

The purpose of this article was to explore nursing experience of a patient with respiratory distress syndrome after abdominal surgery. Nursing care period was from July 3 to July 18, 2014, the author used clinical care, physical assessment, medical records, and case discussion. The caregiver interviewed and other means collect data and use Maslow's human needs theory to conduct an overall assessment and analysis, summarizing the main nursing issues: acute pain, abnormal ventilator withdrawal response, impaired tissue integrity and anxiety. Established a good relationship between illness and trust during care. Let the case know the pipeline and surrounding medical equipment,accept the necessity of existence, and then lead the case and family members to participate in the breathing training and wound care process. Through family support, medical team intervention, and the provision of appropriate analgesics and sedatives, it can improve anxiety and promote wound healing, so that the case can survive the acute respiratory distress syndrome smoothly and cause psychological imbalance, and finally successfully divorced used of the respirator. It is recommended to make a short video of the chest rehabilitation and breathing training group, which will be played in the family lounge to promote family members to participate in the training process. We wished by sharing of nursing experience in this article would provide reference for case care.

並列關鍵字

Respiratory distress syndrome ； acute pain ； wound care ； anxiety

參考文獻

林祐如、賴美玉(2012)‧照護一位因脊髓損傷引發疼痛與焦慮病患之護理經驗‧若瑟醫護雜誌，6(1)，96-106。

Lu, C. F., Chen, M. C., ＆ Shu, S. C. (2012). An Overview of Generalized Anxiety Disorder and Reflections on the Effective Nursing Care of Patients with This Disorder. The Journal of Psychiatric Mental Health Nursing, 7(1), 1-10.

柯獻欽(2009)‧吸入一氧化氮（Inhaled Nitric Oxide, iNO）在急性呼吸窘迫症候群（Acute Respiratory Distress Syndrome, ARDS）之運用‧當代醫學，36(2)，125-138。

林玟秀(2013)‧照護一位呼吸窘迫症候群併發呼吸衰竭之護理經驗‧新臺北護理期刊，15(1)，123-132。

鄭婉如、古雅如、馬瑞菊(2010)‧一位呼吸衰竭插管病患急性疼痛之護理經驗‧領導護理，11(3)，46-59。