慢性阻塞性肺疾病患適應非侵襲性正壓呼吸器之護理經驗

The Nursing Experience of Caring for a Chronic Obstructive Pulmonary Disease Patient and Adaptation to Bi-Positive Airway Pressure

本篇個案報告是協助一位罹患慢性阻塞性肺疾病，合併輕度失智的92 歲女性患者，適應非侵襲性正壓呼吸器的照護經驗。照護期間以Watson關懷理論作為後續照護的基礎與架構，藉由觀察、會談、病歷資料收集，與醫療團隊討論，在急性期時，協助個案適應非侵襲性正壓呼吸器以解決呼吸困難、維持呼吸道通暢與適量的氧合。除此之外，並增加主要照護者的知識與能力，減少疾病的併發症，更利用按摩和宗教音樂減少失智老人所產生的焦慮，同時逐步建立個案信心，協助適應其疾病變化過程與呼吸器使用，並保持良好的生活品質。希望藉此照護經驗，提供有關於運用Watson 關懷理論，協助失智之老年慢性阻塞性肺疾病病患適應使用非侵襲性正壓呼吸器之參考。

This article describes the nursing experience of caring for a patient with dementia and chronic obstructive pulmonary disease while adapting to bi-positive airway pressure (Bi-PAP). Watson’s caring theory was used as the basis for nursing care. Patient’s information was collected through the direct observations of the author, interviews, medical records, and discussions with the clinical care team. During the acute phase, the clinical care team assisted the patient with adaptation to the Bi-PAP by reducing respiratory difficulties and maintaining a smooth airway and proper oxygen saturation. Moreover, the caregivers received health education to enhance their knowledge and skills about Bi-PAP that will reduce relevant complications. The patient received massage therapy and listened to religious music were used to reduce his/her anxiety, along with increasing the patient’s confidence to adapt to disease process and Bi-PAP use. These interventions will reduce the readmission rate and help the patient to maintain a good quality of life. This report can serve as an example using Watson’s caring theory to assist assisting elderly COPD patients with dementia who need to adapt to Bi-PAP.