膽囊切除術後併發呼吸衰竭呼吸器脫離個案之照護經驗

Successful Mechanical Ventilation Weaning Experience for a Patient with Respiratory Failure following Cholecystectomy

本文是探討一位行膽囊切除合併呼吸衰竭個案呼吸器脫離護理經驗，筆者照護期間2010年2月23日至2010年3月4日以Gordon十一項功能性健康評估、運用觀察及會談收集資料，發現個案有呼吸器戒斷反應功能失常、皮膚完整性受損、焦慮、照顧者角色緊張之健康問題。筆者運用個別性及連續性照護，以主動關懷、陪伴，利用衛教單張提供正確的衛教訊息，使其對疾病有正確的認知，並透過其他醫療團隊協助個案暸解呼吸器脫離過程，降低個案對呼吸器脫離過程之焦慮，並傾聽及鼓勵個案女兒說出初次面臨氣切及傷口照護的感受，並教導如何照顧個案，增加對個案的照顧能力，進而達到降低緊張感，期望藉此護理經驗分享，提供護理人員日後照護此類病患之參考。

This report describes a nursing experience of caring for a patient who had difficulty in weaning off the ventilator. The patient was on the ventilator as a result of respiratory failure, a complication developed after a surgery for gall bladder removal. The nursing period was from February 23 to March 4, 2010. The author collected data by means of patient observation and interview, utilizing Gordon's eleven functional health patterns. The major health problems that were identified were dysfunctional breathing resulting from a withdrawal response, impaired skin integrity, anxiety, and the role tension of the caregiver. The author provided individualized continuity of care through active caring and companionship. The patient education sheet was offered to provide information about the disease. Along with other team members' coaching, the patient had a better understanding of the weaning process. The author authentically listened to the patient's daughter regarding her concern about tracheostomy care. The related tracheostomy care was taught to the daughter in order to enhance her confidence of taking care of the patient. All above strategy eased the patient's and family's tension and anxiety. This nursing experience can be referenced by other nurses while caring for similar cases.