急性呼吸窘迫症候群併發呼吸衰竭患者之護理經驗

The Nursing Experience of Caring a Patient with Acute Respiratory Distress Syndrome Complicated Respiratory Failure

本文係探討急性呼吸窘迫症候群個案，經歷重症護理之經驗。筆者於2017年3月27日至2017年4月12日照護期間，運用羅氏適應理論，透過直接照護、整體性之護理評估、筆談及病歷查閱等方式做資料收集。分析主要健康問題有氣體交換障礙、呼吸道清除功能失效及焦慮。藉俯臥姿勢改善氧合狀態，監測血氧變化，進而維持足夠換氣，配合循序漸進的呼吸訓練，漸脫離呼吸器，照護過程中以陪伴、傾聽、關懷的方式了解個案心中的想法和感受，減輕個案所面對的壓力與焦慮，給予言語上的鼓勵、關懷等方法，增進個案的心理安適，建立良好的護病溝通，藉此護理經驗，提供護理人員對於急性呼吸窘迫症候群併發呼吸衰竭患者之護理經驗照護參考。

This paper described the experience of caring a patient with acute respiratory distress syndrome. From March 27 to April 12, 2017, the author employed Roy's adaptation theory for data collection through direct care, evaluation of holistic care, written conversations, and examination of medical records. The major health problems analyzed included disorders in gaseous exchange, impaired respiratory clearance, and anxiety. A prone position was adopted to improve oxygenation status and changes in blood oxygen were monitored to maintain sufficient gaseous exchange in combination with stepby-step breathing exercises to gradually wean the patient off the ventilator. During the care process, companionship, listening, and caring methods were used to understand the patient's thoughts and feelings to alleviate the stress and anxiety faced by the patient. Verbal encouragement and care were used to improve the psychological comfort of the patient and establish good nurse-patient communication. This care experience can provide a reference for nurses to manage patients with acute respiratory distress syndrome and combined respiratory failure.