一位慢性阻塞性肺疾病個案脫離呼吸機之護理經驗

The Nursing Experience of a Chronic Obstructive Pulmonary Disease Patient with Difficult Weaning

本文為協助一位脫離呼吸機三次失敗的慢性阻塞性肺疾病個案，脫離呼吸機之護理經驗。護理期間為2006年8月至2006年11月。筆者以Gordon十一項健康功能模式評估，確認個案護理問題，包括營養狀況改變：少於身體需要、活動無耐力、無望感、呼吸機戒斷反應功能失常。藉由整體性照護提供，與醫療團隊、個案及家屬訂定營養照顧計劃，訓練個案由鼻胃管灌食改為由口進食，繼而提升個案營養狀況；運用丹田式呼吸法和運動訓練增強個案活動耐力；維持個案和重要親友的正向關係，讓個案及家屬主動參與計畫；透過成功患者的激勵，建立個案脫離呼吸機的希望，進而成功脫離呼吸機，希望藉此報告能作為臨床欲脫離呼吸機個案之照護參考。

This article describes the nursing experience of providing care to a chronic obstructive pulmonary disease patient who had three times of weaning failure. Nursing care was performed from August, 2006 to November, 2006. Based on the Gordon 11-items functional health mode, the major nursing issues were confirmed to be malnutrition status, activity intolerance, hopelessness, and dysfunctional weaning response. We made a plan to improve nutrition status by training this patient from NG feeding to self oral intakes, and using tanden breath and exercise training to improve the tolerance of activity. We also made efforts to maintain good relationship between the patient and his relatives to participate in this plan. We introduced previously weaned cases and shared the successful experiences to encourage the patient. From the encouragement, we gave the patient a hope and good intention for liberation of ventilator. Finally, the patient was then successfully weaned from the ventilator. We hope this report can be a reference in managing patient undergoing weaning.