一位氣喘急性發作病患之急診護理經驗

The Nursing Experience of a Patient with Asthma Exacerbation in an Emergency Department

本報告係描述一位氣喘急性發作呼吸衰竭病患之急診照護經驗。急診照護期間，以直接護理、身體評估、觀察及會談等方式收集資料，運用Gordon十項功能性健康型態評估，確立病患主要健康問題為氣體交換障礙、焦慮及健康維護能力改變等。護理期間透過信任感的建立、主動傾聽關懷病患需求、尊重其意見未置入氣管內管改用雙正壓呼吸器，協助有效的呼吸，降低氣喘不適症狀及不安全感，協助渡過危險期；運用積極探視說明以降低病患焦慮感受；提供正確氣喘照護概念，讓病患學習氣喘自我照顧及監測。終使病患在急診照護過程維持足夠的氣體交換，呼吸順暢、情緒平穩，可表達自我感受，並於此次住院期間學習氣喘相關照護，進而提昇自我照顧，順利康復離院。氣喘急性發作病患之急診照護多著重於生理照護挽救生命，由此照護經驗分享，期盼急診護理人員在改善氣喘問題後，提供正確照護資訊及運用，以提升病患自我照顧能力，降低醫療資源之耗用。This article reported the nursing experience of a patient with respiratory failure due to asthma exacerbation in an emergency department (ED). During the ED stay, data were collected via direct nursing care, physical examination, observation, and interviews. Gordon’s 11 Functional Health Patterns were used to identify the main health problems of this case, including impaired gas exchange, anxiety, and ineffective health maintenance. During the nursing period, we gained the patient’s trust and actively listened to her needs. We respected her will to choose Bi-level Positive Airway Pressure (BiPAP) mask instead of endotracheal tube intubation, which would facilitate effective ventilation, reducing the patient’s discomfort and insecurity due to asthma, and help the patient to overcome this crisis. Frequent visits and explanations were also provided to alleviate anxiety. The patient could learn self-care and self-monitor of asthma status by providing her correct concept of asthma care. Finally, the client was able to maintain adequate gas exchange, smooth respiratory pattern and mood, and the ability of self-expression through the emergency care. Since the client received the education of asthma care during this hospital stay, her self-care ability improved and she was discharged successfully after recovery. The emergency care of asthma exacerbation usually focuses on life-supporting physical care. By sharing this care experience, we expect emergency nursing professionals to not only correct symptoms of asthma but also provide accurate care information for patients. As a result, we can enhance the self-care ability of patients and furthermore reduce the waste of medical resources.