一位48小時非計畫性重置氣管內管病患之加護經驗

The Nursing Experience of Caring For a Patient with Endotracheal Reintubation

本文主要探討一位94歲個案，在成功脫離呼吸器後，於48小時內，因家屬灌食後嗆入引發呼吸困難，導致重置氣管內管再入加護病房之護理經驗。護理期間自2009年2月1日至2009年2月15日，筆者於照顧期間藉自身體評估、觀察、傾聽及與家屬會談等方式，收集個案身心靈社會等相關資料，分析歸納其主要護理問題包括，個案生理上因嗆入引發肺部發炎，造成肺泡與微血管膜改變導致氣體交換障礙；心理上因插管經驗及環境威脅刺激而引發恐懼的護理問題；另外，深刻體會到家屬的緊張與自責，故有照顧者角色緊張與疾病嚴重度增加及照護技巧不熟練有關的護理問題。在護理過程中，透過個別性護理，並與醫療團隊共同努力，有效恢復正常呼吸型態，順利移除氣管內管；並透過陪伴、傾聽、治療性觸摸及鼓勵情緒表達，協助個案有效減輕恐懼感，另外透過護理指導、給予心理支持及鼓勵參與照護，增強家屬信心，提升照顧能力，進而改善生活品質，期望藉由此護理分享，可做為日後護理人員在照顧此類病人之參考。

This report discusses the nursing experience of caring for a patient who frequently choked within 48 hours after removing the endotracheal tube from the respirator. The patient was reintubated and readmitted to the intensive care unit. The author collected data from February 2 to 15, 2009, through physical examination, observation, listening, and interview. Identified main problems were impaired gas exchange, fear, and caregiver role strain. During the nursing process, we provided individualized care and cooperated with other health care providers. To increase the confidence and capability of the caregiver, the author also gave the caregiver emotional support and patient education. The author expects this nursing experience to serve as a reference for other nurses when they meet the similar cases in the future.