照顧一位孕婦感染H1N1產後之重症護理經驗

A Critical Care Experience of a Postpartum Woman who Contracted H1N1 Influenza during Pregnancy

孕婦感染H1N1併發重症危及生命易造成胎兒窘迫，此時搶救母體及胎兒為一重要課題。本文描述一位34週孕婦感染H1N1併發呼吸道重症的個案，藉由觀察、身體評估及會談收集資料，確立個案有氣體交換障礙、管路及傷口高危險性感染、害怕死亡、隱私權受侵犯等主要健康問題，住加護病房期間在呼吸道照護採密集胸腔物理治療、清除呼道分泌物照護，利用肺部影像及動脈血液氣體的變化監測病情進展，同時採全面感染防制措施預防繼發性感染之合併症。以疼痛評估、持續止痛照護及注意姿勢促進舒適，運用認同宗教信仰，滿足思念孩子的需求，給予適時肯定及提供希望，重建個案與孩子、先生一起生活的期待，渡過死亡威脅。面對媒體追逐的新聞，採多方維護保護病人隱私，最後母子均安且一家滿意出院。

Intrauterine fetal distress caused by complications resulting from H1N1 influenza infection during pregnancy is life-threatening to both a mother and her fetus. This case report described the nursing experience of caring a-34 week- pregnant woman who had H1N1 virus infection complicated with severe respiratory distress. Through observation, physical examination, and interview, four major nursing diagnoses were identified, including impaired gas exchange, high-risk for tubing and wound infection, fear of death, and privacy violation. At the intensive care unit, the interventions for treating respiratory distress were intensive chest care therapy and effective airway clearance method; for detecting the progression were a series of chest x-ray and multiple arterial blood gas tests. To prevent secondary infection, meticulous infection control measures were implemented. Also, the individualized care plan was carried out, which included performing continuous pain assessment and management, maintaining body alignment and comfort, identifying patient’s spiritual needs, meeting the needs of affections for the children, offering appropriate assurance, helping to reestablish the expectations of living with her family, and eliminating the feeling for the threat of death. Last but not least, our team made much effort to protect patient’s privacy from exposure to the mass media. Finally the patient and the infant were discharged with good condition and great satisfaction.