運用肺部復健照護一位慢性阻塞性肺疾病患者之經驗

Experience by applying pulmonary rehabilitation to a COPD patient

本文為探討運用肺復健照護一位72歲女性患者罹志慢性阻塞性肺疾病息者之經驗，個案自1999年診斷慢性阻塞性肺疾病， 2003 年起因呼吸困難及多次呼吸道成染症狀，反覆入院治療。此次因呼吸道成染引發呼吸喘、高碳酸血症，於急診放置氣管內管並使用呼吸器以維持呼吸系統功能， 2010年8 月26 日至2010 年9 月27 日護理期間，藉由直接照顧、觀察、溝通、會談等方式收集資料，依個案生理、心理、社會及靈性四大層面加以分析歸納。個案主要護理問題為自主性換氣失效、呼吸機戒斷反應功能失常、焦慮。經由筆者計畫性護理並以自我照護為原則，運用肺部復健運動及正向的鼓勵等護理措施，改善個案呼吸困難、增加呼吸的耐受力，回復病人獨立的功能及維持其生活品質。This case report aims to explore the experience by applying pulmonary rehabilitation to a 72 year-old female Chronic Obstruction Pulmonary Disease (COPD) patient. This case was diagnosed with COPD in 1999 and has been readmitted many times due to dyspnea and respiratory infection since 2003. This time the case suffered from respiratory infection combined with wheezing and hypercapnia followed by endotracheal tube intubation with mechanical ventilator in emergency room to maintain respiratory function. Data was collected by directive care, observation, communication, and interview with this patient from 26th, August, 2010 to 27th, September, 2010, and was analyzed with an inductive method based on her physical, psychological, social, and spiritual aspects. The major nursing problems were autonomous ventilation failure, ventilator weaning response, and anxiety. With self-caring principle, planned-nursing care by applying pulmonary rehabilitation and positive encouragement, the author successfully helped this case recovered from dyspnea, increase respiratory tolerance, recover independent living ability, and maintain the quality of her life.