一位氣管狹窄患者接受氣切手術之護理經驗

The Experience of Caring for a Patient with Tracheal Stenosis after Tracheostomy

氣管插管外傷、吸入性損傷、反覆感染等因素都會造成氣管狹窄，嚴重甚至造成呼吸窘迫。本文敘述一位全身性紅斑狼瘡病人，因氣管狹窄引發呼吸困難而執行氣管切開術，術後氣切管留置期間運用個別性護理措施順利協助病人度過身心困擾之護理經驗。護理期間2010年2月19日至3月17日，筆者採用Gordon十一項功能性健康型態為評估架構，運用同理心及持續的關懷、傾聽，藉此與病人建立治療性的人際關係，透過有系統的觀察、紙筆溝通、治療性會談及查閱病歷等方式收集資料，分析歸納主要的護理問題有呼吸道清除功能失效、焦慮及身體心像紊亂，護理過程中考慮病人之個別性與整體性需求，術後維持呼吸道通暢為首要護理措施，以預防痰液堆積，減輕肺部合併症，經由提供氣管切開術後之護理指導，促進病人對氣管切開術後之認知，並鼓勵說出心裡的感受，針對其擔心之事，予詳細解釋、澄清疑惑，以減輕其焦慮程度，使病人願意坦然面對疾病與漸漸接受自己術後身體外觀的改變。

Factors such as endotracheal intubation injury, inhalation injury, and recurrent infections can cause stenosis, even leading to severe respiratory distress in a worst-case scenario. This study describes successful individualized interventions for a systemic lupus erythematosus patient with difficulty in breathing due to tracheal stenosis undergoing tracheotomy. During the nursing period from February 19 to March 13 2010, Gordon's Functional Health Patterns was used for assessment, empathic listening skills and continuous concern were demonstrated to establish therapeutic relationship, and systematic observation, pen-and-paper communications, therapeutic interview as well as medical record review were utilized to collect data. According to the results of data analysis, major problems encountered by nurses included ineffective airway clearance and anxiety as well as body image disturbance in the patient. The primary goal of tracheostomy care is to maintain the patency of the airway for the prevention of mucus accumulation and pulmonary complications. By following tracheostomy care guide and providing care information to the patient, we successfully improved the patient's knowledge about tracheotomy and reduced the patient's anxiety by encouraging discussion of feelings and answering concerns. The patient finally accepted the diagnosis and confronted with the change in appearance made by the procedure.