一位慢性阻塞性肺疾病病人使用非侵襲性正壓呼吸器之護理經驗

Non-invasive Positive Pressure Ventilator in Chronic Obstructive Pulmonary Disease Patient: A Nursing Experience

本文描述一位罹患慢性阻塞性肺疾病個案，因急性發作引發呼吸衰竭，住院期間合併使用非侵襲性正壓呼吸器，且成功返家的照護經驗。護理期間自2014年8月6日至2014年8月29日，於護理過程中運用身體評估、觀察會談，臨床照護、病歷查閱等方式收集資料，歸納分析個案問題有呼吸道清除功能失效、活動無耐力、知識缺失等健康問題。以跨團隊完整性照護計畫，包括偕同醫療團隊如呼吸治療師、營養師、居家護理師等，與個案及家屬共同參與漸進式呼吸訓練及活動力促進方案，並適時介入疾病衛教及出院準備服務，透過居家呼吸照護資訊及社會資源的運用，鼓勵家屬參與照護，並漸進式訓練個案增進自我照護能力，促使個案順利返家，護理過程充分展現連續性及整體性的醫療照顧，期望藉由此成功案例的分享，讓個案及家屬可以適應並面對疾病變化過程，保有正向積極的態度及良好的居家生活，提供護理同仁臨床照護的參考。

This article describes the nursing experience of a patient with chronic obstructive pulmonary disease (COPD) withacute exacerbation who received non-invasive positive pressure respirator treatment during hospitalization. The nursingperiod was from August 6 to 29, 2014. The author collected data through a physical assessment, observation, interview,clinical care, and chart review. The nursing problems identified included purge function fails, activities intolerance andlack of knowledge. With the multidisciplinary team members, such as respiratory therapists, dietitians, and home carenurses, the patient and family participated in the progressive breathing exercises and activity promotion program. Inaddition health education and discharge planning were provided. The family was encouraged to participate in increasingself-help ability of the patient in order to help the patient discharge through information of home respiratory care andmultiple social resources. This nursing process fully shows continuity and integrality of care. By sharing this nursingcare experience, we expect that the patient and family not only positively face disease process but also keep a positiveattitude and healthy living. Furthermore, this successful care experiences could serve as a reference for nursingcolleagues and clinical care.