一位肺炎併發呼吸衰竭脫離呼吸器個案之護理經驗

A Nursing Experience for the Patient Weaning Off Ventilator

本文是一位62歲男性個案，有慢性阻塞性肺部疾病，不曾住院，此次因感冒發燒，卻面臨到突如其來的轉變插管住進加護病房治療，對於無法順利脫離呼吸器，感到無限沮喪，而轉入呼吸照護中心之照護經驗。筆者在2010年01月02日到01月21日照護期間，運用Gordon十一項功能健康型態進行整體性評估，結果顯示個案有呼吸道清除功能失效、焦慮及睡眠型態紊亂等健康問題。照護期間筆者教導個案運用手助式咳嗽、增加自咳能力、執行胸腔復健運動及提升呼吸肌耐力；藉由紙筆方式與個案溝通，鼓勵及引導個案說出心理的感受、經同病室內呼吸器脫離成功案例同意，與個案分享脫離呼吸器成功之心路歷程；提供個案喜愛之心靈音樂播放、調整個案擦澡時間並加上背部按摩及同時彈性安排個案妻子入病室陪伴入眠等措施。在醫療團隊共同的努力下，個案成功脫離呼吸器轉出病房，病癒後順利出院，回歸日常生活。期望藉此照護經驗分享，使臨床護理人員能早期協助病患面對疾病的變化所帶來的衝擊，並能尊重病患的個別性及感受以提供完善的護理措施。期望藉此個案照護經驗分享，運用於臨床護理實務，為日後臨床照護之參考。

This report describes a 62-year-old male patient with chronic obstructive pulmonary disease without a history of hospitalization. The patient was suffering from respiratory failure secondary to pneumonia, which was triggered by a recent flu attack. The patient was adm itted to the intensive care unit for emergent intubation and use of ventilator. The patient was extremely frustrated and depressed for failure of weaning off the ventilator. The patient was transferred to the respiratory care center (RCC). The nursing care period was from January 2 to 21, 2010. Data were collected through the use of Gordon's 11 Functional Health Patterns for integral assessment. The three identified health problems were ineffective airway clearance, anxiety, and sleep disorder. Patient was instructed how to deal with effective cough with manual assistance to enhance clearance of the airway. Pulmonary rehabilitation s trengthens the patient's durance of the respiratory muscles. The patient was encouraged and guided to express his feelings through writing. Sharing the patient's experience with other patients undergoing a similar situation helped reduce his stress. Other nursing interventions included providing the patient with his favorite music, adjusting his time for sponge bath and back message, and allowing his wife as a companion during the patient's sleep. With the care team's efforts, the patient succeeded in weaning off the ventilator and was discharged under a stable condition. The purpose of sharing this nursing experience is to expect nurses to assist patients in facing disease impacts, and to respect patients' individualization and feeling while providing comprehensive nursing measures. This article may be used as a reference for clinical nursing practices.