一位慢性阻塞性肺疾病急性惡化之急診護理經驗

A Nursing Experience of a Patient with Acute Exacerbations of Chronic Obstructive Pulmonary Disease in Emergency Department

本文描述88歲男性罹患慢性阻塞性肺疾病20年，初次經歷急性惡化之急診護理經驗，照護期間為2018年2月25日至26日，經由會談、觀察、身體評估、病歷查閱等技巧收集資料，並運用Gordon十一項健康功能性健康評估，主要健康問題為低效性呼吸型態、現存性感染及焦慮等。急診護理初期介入提供藥物治療、足夠的氧氣及教導有效呼吸技巧，改善肺炎併呼吸喘之問題。在急性期後，教導個案漸進式活動，並衛教肺部復健運動以防再次急性惡化，及定期接種流感和肺炎球菌疫苗可降低呼吸道感染發生，進而減輕焦慮之導因。未來建議臨床優化資訊建置，以軟體設備紀錄個案運動及用藥情形，方能追蹤長期健康成效。期望藉由此護理經驗提供照顧類似個案之急診護理人員參考。

This case report describes the emergency care of an 88-year-old man, who had chronic obstructive pulmonary disease for 20 years, during his first visit to the emergency room due to acute exacerbation of the disease. The nursing period lasted from February 25 to 26, 2018, during which data were collected using interviews, observations, physical assessments, and reviews of medical records. Using Gordon's 11 functional health assessments, the patient's main health problems were found to be as follows: inefficient breathing patterns, existing infections, and anxiety. During early emergency care intervention, treatment included medication, adequate oxygen, and the teaching of effective breathing techniques for improving pneumonia and respiratory problems. We taught the patient the usefulness of gradually increased physical activity, respiration rehabilitation exercise to prevent acute deterioration, and the importance of regular vaccination against influenza and pneumococcal to reduce the incidence of respiratory infections. These measures reduced his anxiety after the acute phase of emergency care. Clinical optimization of information should be established, and the long-term health outcomes of patients can be tracked by recording the case movements and medications using software. We hope that this nursing experience will provide a reference for emergency staff with similar cases. (Tzu Chi Nursing Journal, 2020; 19:2, 127-136)