運用羅氏適應理論於一位格林－巴瑞症候群併呼吸訓衰竭患者之加護經驗

Applying Roy's Adaptation Model in Caring for a Patient Suffering form Guillain-Barre' Syndrome with Respiratory Failure

本篇個案報告是照護一位格林－巴瑞症候群併呼吸衰竭病人之護理經驗。護理期間為2016／3／5至2016／3／25，運用羅氏適應模式的第一層次及第二層次評估方式，收集主客觀資料並且分析內外刺激源，確立呼吸道清除功能失效、身體活動功能障礙、焦慮等三個主要護理問題。住院期間運用團隊資源、協調復健人員與呼吸治療師共同介入，配合呼吸肌力訓練計畫，提供支持、照護和正向回饋，使個案能面對疾病的治療、提升呼吸訓練的成效及減緩焦慮，最後讓個案成功適應脫離呼吸機的生活，幫助個案在生理模式、自我概念、角色功能、相互依賴等各模式中獲得調適，並逐漸恢復四肢肌力及提升自我照顧能力。藉由此照護經驗的分享，作為護理人員日後在照護此類病人之參考。 This article describes the nursing care experience of a patient with respiratory failure who was diagnosed with Guillain-Barre' syndrome. The nursing period was from 5th to 25th March 2016. Using the first and the second level assessments in Roy’s theory to evaluate the patient’s changes and stimuli in Physiological-Physical mode, Self-Concept Mode, Role functional mode and Interdependence mode. Three nursing diagnoses were identified, including ineffective airway clearance, physical activity dysfunction and anxiety. Cooperated with the Physiatrist and Respiratory therapist, we provided the plasma exchange treatment, training projects strengthen the muscles of respiration, nursing interventions and mental support. Therefore, we helped the patient reduced anxiety and made efforts to the spontaneous breathing trial and the rehabilitation programs. Finally, the patient had successfully weaned from the mechanical ventilator, learned positive coping responses and promoted the self-care abilities. This nursing experience serve as a reference for the future clinical practice.