一位合併肺栓塞之腎病症候群青少年患者的急症照護經驗

A Critical Nursing Care Experience with a Juvenile Patient with Pulmonary Embolism Secondary to Nephritic Syndrome

本文係運用羅氏適應模式理論協助一位合併肺栓塞之腎病症候群青少年患者，滿足其在入住加護病房期間，其身、心理需求的照護經驗。照護期間為2007年5月6日至2007年5月7日。透過身體評估、實地觀察、訪談、書信溝通等，確立個案之護理問題為組織灌流改變、身體心像紊亂、無力感等護理問題，個案經由加護病房醫療團隊積極治療之後，改善了組織灌流不足之問題，也已由非侵入性雙正壓型呼吸器(Bi-level Positive Airway Pressure；BIPAP)改為鼻導管ZL/min使用。而心理方面，運用同理心、傾聽技巧並適時給予回應，提供疾病相關資訊之護理指導，加強個案自我照顧能力及有效的支持系統，並順利發展出適應行為。透過本篇個案報告，期望可以提供加護病房護理人員日後照顧此類青少年患者完整身、心理照護之參考。

This essay described the experience of nursing a juvenile patient with pulmonary embolism secondary to nephritic syndrome, with the application of Roy's Adaptation Model, in the intensive care unit from May 6, 2007 to May 7, 2007. With physical assessment, on-site observation, interview, and writing, the identified nursing diagnosis were poor tissue perfusion, impaired body image, and powerlessness. Through aggressive medical treatments, poor tissue perfusion was corrected by the use of an invasive bi-level positive airway pressure (BiPAP) ventilator. The patient's respiratory function was maintained at two liters of oxygen per minute via a nasal cannula. In order to provide the patient with psychological support and developing adaptation to the disease, the author cared for the patient by emphasizing proper communication skills, such as empathy and active listening. The author enhanced the patient's knowledge about the disease and the ability of coping and self-care with a surrounding supporting system. The purpose of this essay was to provide the ICU nurses with a reference in regards to nursing care for juvenile patients.