照護一位呼吸窘迫症候群併發呼吸衰竭之護理經驗

The Nursing Experience of a Case with Respiratory DIStress Syndrome Complicated by Respiratory Failure

本文在探討照顧一位初次罹患肺炎進展急性呼吸窘迫症候群併發呼吸衰竭的經驗，護理期間為2010年5月14日至2010年5月26日，筆者運用Gordon十一項健康功能型態評估架構，藉由臨床照護、身體評估、個案筆談、主要照顧者會談及查閱病歷資料等方式，分析歸納主要護理問題為：氣體交換障礙、焦慮、睡眠型態紊亂。配合循序漸進的呼吸訓練及胸腔復健運動，增進心肺功能協助脫離呼吸器。個案因陌生環境、氣管內管放置無法表達言語，加上本身雙耳重聽產生的溝通障礙，透過主動的關懷、耐心的運用筆談建立默契，與個案建立良好的護病關係，由個案的一舉一動去深入了解個案的需求及感受，藉由以同理心、正向鼓勵，並彈性的增加會客時間、安排家屬陪伴，並放置個案熟悉的物品，降低病患對溝通障礙上及陌生環境導致的焦慮及睡眠問題。藉由筆者的照護過程分享，期許臨床護理人員依個案需求提供個別性的照護。This article aims to describe and explore the nursing experience of a case who had pneumonia for the first time and then progressed to respiratory distress syndrome complicated by respiratory failure. The nursing period started from May 14th to 26th, 2010. In this article, Gordon's 11 functional health patterns were used as the framework for patient assessment, and data were collected from various aspects, including the clinical nursing care, physical assessment, conversation by writing with the case, interviews with the major caregivers, and consulting the medical clinical records of the case. After the data had been analyzed and summarized, the major nursing problems were then confirmed, which included gas exchange dysfunction, anxiety, and sleep pattern disturbance. Furthermore, proper step-by-step courses of respiratory training and pulmonary rehabilitation were also adopted to improve heart and lung function in order to help the case to remove the respirator. The case could not speak due to the strange environment and the endotracheal tube placement, and also had communication barriers resulting from binaural hearing loss. By actively providing patient care and establishing an excellent bonding between each other through the conversation by writing with patience, the author attempted to obtain a better understanding of the needs and feelings of the case from his behaviors and attitudes. Moreover, in order to reduce the case's anxiety and sleep problems caused by communication barriers and unfamiliar environment, the companion time of the case's family increased with a high level of flexibility. The objects that the case was familiar with were placed in the hospital room. The case was positively encouraged by the author and his family members with heartfelt sympathy. By sharing the nursing process, the author hopes that the clinical nursing staff can provide individualized nursing care according to the needs of each case to enhance the quality of life.