一位先天性中樞性換氣不足合併全腸道神經缺乏症嬰兒之護理經驗

Nursing Experience for an Infant of Congenital Central Hypoventilation Syndrome with Hirschsprung’s Disease

本文係探討一位先天性中樞性換氣不足合併全腸道神經缺乏症病嬰面臨生理功能不穩定之護理經驗。個案於出生後第二天即由外院經急診轉入新生兒加護病房，由筆者主治護理期間為2006年4月17日至5月30日，以實際參與護理個案，並藉由身體評估及觀察個案行為等方式確立個案有低效性呼吸型態、皮膚完整性受損、睡眠型態混亂及混亂性嬰兒行為等健康問題。針對上述護理問題，筆者運用照護過程擬定護理計劃及提供適當及個別性照護措施，使個案的健康問題獲得改善，其中包括個案因侵入性治療哭泣時監測個案血氧飽和度並快速予以安撫以減少出現憋氣情形能漸漸穩定呼吸狀況；照護腸造瘻口及其周圍皮膚，防止因潮濕或浸潤而發紅破皮；在活動及睡眠方面除盡量配合個案作息，集中護理並減少環境中過多的刺激如：燈光、音量、頻繁的治療，使個案有完整的睡眠，期望藉由此護理經驗，提供日後臨床護理人員照護類似病患之參考。

In this case, we investigated the nursing experience for the physically unstable situation of an infant of congenital central hypoventilation syndrome with Hirschsprung’s disease. This infant was transferred through emergency room to the neonatal ICU at the second day after birth. The author took care of him starting from Apr. 17 until May 30, 2006. This infant’s health evaluation was determined through physical examination and behavioral observation. The patient’s problems included ineffective breathing pattern ,impaired skin integrity, disturbed sleep pattern, and disorganized infant behavior. To improve the patient’s health problems, we stabilized the respiratory situation through monitoring his blood oxygen saturation, and quickly pacified him during invasive treatment to lessen breath-holding while crying. Moreover, nursing care of enteral fistula and skin was provided to prevent skin redness and peeling due to humidity or infiltration. Activity and sleep schedule were rearranged in accordance with his body clock, meanwhile concentrated nursing procedure reduced excess stimulations, e.g. lights, noise, frequent treatment. We provided individual and complete nursing measurements to prevent interruption of his sleep. Finally, his overall conditions improved significantly. We hope this experience is helpful for clinical nursing staff to deal with similar cases.