一位慢性阻塞性肺疾病病患之急診護理經驗

The Nursing Experience of a Patient with Chronic Obstructive Pulmonary Disease in Emergency Department

本文描述一位因慢性阻塞性肺疾病致呼吸困難多次重返急診個案之護理經驗。此次因呼吸喘再入急診，透過緊急醫護處置，生命徵象穩定後，2006年3月18日至22日急診留觀，以直接護理、會談及觀察方式收集資料，運用Roy's Model評估，確立有低效性呼吸型態、活動無耐力及知識缺失等護理問題。藉由正確呼吸訓練，改善通氣狀態維持足夠氧合，安排漸進式運動訓練增加活動耐力，衛教指導加強疾病認知，終使個案病情改善順利出院。於個案門診返診日前後電話關懷，皆能配合定時返診，且長達6個月未再急性發作重返急診。慢性阻塞性肺疾病患者重覆急性發作就診，急診都以改善症狀為處置要務，少深入探究個別重返原因，致這些病人一直處於『週而復始，反覆輪迴』情境，期以此照護經驗與護理同仁分享，做日後照顧此類患者之參考。

This article is about a nursing experience of a patient complaining of recurrent dyspnea and repeated Emergency Department (ED) visits because of chronic obstructive pulmonary disease (COPD). This time, the patient made another ED visit for shortness of breath. After stabilization of vital signs by means of emergency medical treatment during ED stay from March 18 to 22 2006, we gather our data via direct nursing measures, consultation and obervation. In addition, we applied Roy's model and confirmed quite a few nursing problems such as low efficacy respiratory pattern, exercise intolerence, and cognition deficiency. We also adopted correct respiratory training, improvement of ventilation oxygenation, progressive exercise training to improve physical tolerance, and health instruction to improve the understanding of the disease. The patient was finally discharged uneventfully. We followed up the patient after discharged on the telephone. The patient was able to return to out-patient clinic as schedule. In addition, the patient hadn't made another ED visit for acute exacerbation for the next six months. In conclusion, we often take stabilization of symptoms as our priority in ED instead of digging deep into the reasons of repeated ED visits. Therefore, these patients are always in a dilemma of discharge and return. We hope that the sharing of the nursing experience can be beneficial to nursing staff when treating patients with similar situations in the future.