一位肺氣腫引發氣胸併行多次肋膜黏合術個案之護理經驗

A Nursing Experience of a Patient with Emphysema Complicated with Pneumothorax Underwent Multiple Pleurodesis

本文為一位肺氣腫併氣胸病人，接受胸腔鏡內視鏡影像輔助手術後因肺擴張不全歷經三次肋膜黏合術之護理經驗。護理期間為2013年3月4日至3月28日，依Gordon十一項功能性健康形態為護理評估架構，透過觀察、會談及身體評估收集資料，歸納主要健康問題：1.低效性呼吸型態－血氧偏低╱與氣胸疾病有關，2.活動無耐力╱與氣體交換及氧氣供應失衡有關，3.焦慮╱因對疾病治療與經濟的不確定感導致有關。針對低效性呼吸型態導致活動無耐力，提供行Triflow訓練等個別性護理措施。另因疾病重複性治療，擔心費用的不確定感而引起焦慮，藉由醫療團隊合作予病情解釋；會診社工科予經濟上的協助讓個案安心治療。藉此經驗提供同仁日後照護相關個案之參考。

The article describes the nursing experience of a patient emphysema complicated with pneumothorax, who underwent three pleurodesis due to pulmonary atelectasis after videoassisted thoracoscopic surgery (VATS). The nursing period lasted from March 4 to March 28, 2013. The author used Gordon's 11 functional health pattern as an assessment framework, collected data through observation, interview, and physical assessment, and identified the following nursing problems: ineffective breathing pattern due to pneumothorax, activity intolerance due to impaired gas exchange, and anxiety associated with uncertainty regarding treatment plan and financial status. Activity intolerance due to ineffective breathing pattern was addressed by the introduction of individualized Triflow breathing exercise; anxiety induced by repeated pleurodesis and financial uncertainty was addressed by a briefing from the medical team on the his condition and financial support provided by the social workers. The author wishes to share this nursing experience with other nurses to serve as a reference when tending patients with similar conditions.