照顧一位腦部動靜脈血管畸形破裂個案脫離呼吸器之護理經驗

A Nursing Experience of Weaning a Brain AVM Patient off the Mechanical Ventilator

本報告探討一位腦部動靜脈血管畸形破裂後造成出血性腦中風其脫離呼吸器過程之護理經驗。經由觀察、會談技巧並以Gordon十一項功能性健康形態評估收集資料，將照護期間中個案及家屬所表？的語言及非語言行為加以記錄、整理及分析，確立主要的護理問題有：1.呼吸器戒斷反應功能失常、2.身體活動功能障礙及3.照顧者角色緊張。護理過程透過關懷、同理心、鼓勵表？內心感受及耐心傾聽等技巧，並針對各項健康問題提供適切及個別性的護理指導，制定適合個案的呼吸器脫離訓練計畫及肺部復健措施，協助並教導家屬執行復健運動及照護技巧，使其身心？到完整的照護，並滿足家屬的需求，降低其壓力及焦慮。藉此個案之護理經驗，期盼於專業領域中提供經驗分享。

This article describes a nursing experience of caring for a patient who underwent weaning from the mechanic ventilator. The patient suffered from a hemorrhagic stroke secondary to arteriovenous malformation (AVM). Applying Gordons 11 Functional Health Patterns Assessment Tool, the author collected data via clinical observation and interview. During the caring period, the author documented, compiled and analyzed both the patient and the family's expressive behaviors in both verbal and nonverbal ways. The identified major nursing problems were failure to respond to weaning from the mechanical ventilator, functional disturbance in physical activity, and the caregiver's role tension. By caring with empathy and actively listening, the author encouraged the patient and family to express their inner feelings. The author also offered to teach the patient about individual health problems, designed a training plan to wean the patient off the mechanic ventilator and pulmonary rehabilitation measures, and assisted in teaching the family how to implement rehabilitative exercise and caring skills. All these interventions provided the patient with integrative care, satisfied the family's needs，and lowered their stress and anxiety. The author wished to share this nursing experience with other nursing professionals in the specialty.