一位瓣膜置換術後病人成功脫離呼吸器之重症護理經驗

A Critical Nursing Experiences of Weaning a Heart Valve Replacement Patient from a Ventilator After Surgery

本文描述一位罹患主動脈瓣膜狹窄二度施行瓣膜置換，術後面臨無法脫離呼吸器之護理經驗。照護期間2014年2月20日至3月20日，藉由收集個案相關問題進行整體性護理評估，發現個案有呼吸機戒斷反應功能失常、活動無耐力、潛在危險性感染及無望感之問題。照護過程中，有計畫的呼吸訓練及教導四肢全關節運動運用於生活中，增進心肺功能而成功脫離呼吸器，同時執行傷口管路照護，做好預防感染，建立良好護病關係。藉由宗教力量增加勇氣，學習與疾病共處、增進心肺復健意願，提供符合個別性護理措施，發揮護理專業角色及技巧，使其能正向調適，克服無望感等生心問題，共同面對生命難關。

The paper describes the nursing experience of an aortic valve stenosis patient who could not wean from a ventilator after receiving his second valve replacement. The nursing period lasted from Feb. 20th to Mar. 20th, 2014. Data were collected for holistic nursing assessment. After analysis, it was found that the patient suffered from dysfunctional ventilatory weaning response, activity intolerance, risk of infection, and hopelessness. During the nursing period, planned breathing exercise and upper and lower limb joint exercise were taught to the patient to successfully wean from the ventilator by strengthening cardiopulmanory function; wound and tube care was performed to ensure infection prevention and to establish positive patientnurse relationship. The patient was encouraged to coexist with the disease, and to willingly engage in cardiopulmanory rehabilitation, through the introduction of religion. Individualized nursing interventions were provided, utilizing the professional role and skills or the nurses, to facilitate positive coping, overcome hopelessness, and to face current predicament.