一位魯特維格氏咽峽炎患者呼吸器脫離訓練之護理經驗

Nursing Experience of Weaning a Patient with Ludwig's Angina from Mechanical Ventilator.

呂靖雯(Ching-Wen Lu) ； 吳玉萍(Yu-Ping Wu)

《若瑟醫護雜誌》 8卷1期 (2014/08) Pp. 88-101

摘要

魯特維格氏咽峽炎為口腔底部的急性蜂窩組織炎，其最嚴重的併發症為呼吸道阻塞造成呼吸困難。本文描述一位魯特維格氏咽峽炎併發呼吸衰竭患者進行呼吸器脫離訓練過程之護理經驗。護理期間由2011年4月18日至5月20日，以Gordon十一項功能性健康型態進行護理評估，透過觀察、會談、紙筆書寫、嘴型辨識、身體評估與病歷查閱等方法收集相關的資料，確立個案有呼吸道清除功能失效、組織完整性受損、失眠及無力感之護理問題。照護期間除醫療處置外，利用教導有效咳嗽和正確的胸腔物理治療，以促進痰液排出；針對頸部傷口除了每日傷口護理外，另諮詢營養師提供足夠的熱量、蛋白質和維生素，使傷口癒合且沒有感染；透過了解失眠主因及白天安排適當運動量，改善夜眠不足的問題；鼓勵表達內心感受和參與自我照護，協助個案了解目前身體狀況並協同家屬適時給予心理支持，緩解因長期使用呼吸器而產生的無力感。藉此護理經驗增加個案呼吸器脫離成功的機會，並做為日後臨床工作者在照護此類患者時之參考。

關鍵字

魯特維格氏咽峽炎 ； 呼吸器脫離 ； 組織完整性受損

並列摘要

Ludwig's angina is regarded as a rapidly spreading cellulitis involving the mouth floor, and the most severe complication was dyspnea due to the obstructed airway. This article described a nursing experience of caring a patient with Ludwig's angina and respiratory failure during weaning from ventilator. The nursing period was from April 8th, 2011 to May 20th, 2011. The author used Gordon 11 Functional Health Patterns Assessment as observation, writing, lip reading, physical assessment and chart review to identify the nursing problems. The nursing problems included ineffective airway clearance, impaired tissue integrity, insomnia and powerlessness. In addition to medical treatment, the author taught the patient the skills of coughing and provided appropriate physical therapy to alleviate sputum accumulation. The author not only provided neck wound care daily but was also assisted by dieticians to supply sufficient energy, protein and vitamin to promote wound healing. To solve the problem of sleep deficit, we investigated the cause of insomnia, and encouraged patient to exercise during the daytime. The author encouraged the patient to express his emotions and participate in self-care, at the same time, provided relevant information on the disease and offered phychological support with family, in order to reduce his feeling of powerlessness caused by prolonged mechanical ventilation. We hoped that this nursing experience could help to increase the chance of weaning of ventilator and serve as a reference for the clinical nursing staff in provision of care for similar patients.

並列關鍵字

Ludwig's angina ； wean ventilator ； impaired tissue integrity