照顧一位罹患A型流行性感冒病毒合併肺炎孕婦之急診照護

Emergency Care for a Pregnant Woman with Influenza a Viral Infection and Pneumonia

流行性感冒病毒為每年季節性之常見呼吸道疾病，其中引發肺炎大多為A型病毒。本文描述一位結婚多年經歷三次人工受孕後成功之36歲孕婦，就醫當日因高燒及呼吸喘被診斷A型流行性感冒病毒，治療過程雙側肺部浸潤嚴重合併肺炎，醫師建議轉至加護病房。急診照護期間為2018年2月18日至2月20日，筆者運用觀察、訪談、家屬會談、臨床數據等方式收集資料，並運用Gordon十一項功能性健康型態進行整體性護理評估，確立個案健康問題包括氣體交換障礙、焦慮及照顧者角色緊張。照護過程中給予氧氣及抬高床頭增加血液灌流量，改善呼吸喘症狀，以傾聽、陪伴、主動告知胎兒健康狀況，引導個案說出對於胎兒的擔憂及感受，運用家人支持與關懷，減輕焦慮及內心自責。留院觀察期間案夫因照護經驗不足產生極大壓力，提供肺炎照護指引增加對疾病照護技巧，減少緊張感。最後於醫療團隊照護下順利產下一位健康男孩。在急性醫療所面臨的立即處置，醫護人員與個案短暫接觸，不僅須快速提供治療及改善生理問題，對於心靈層面，若能多些技巧及提供支持，對於倉皇、無措的個案甚至對照顧者必能擁有莫大幫助，期盼藉此護理經驗分享，提供臨床護理師照護參考，協助個案度過疾病急性期。

Influenza virus infection is a common seasonal respiratory disease. Infection from influenza A virus often induces pneumonia. In this article, the author described the nursing experience of caring a 36 year old pregnant woman who has been married for years and experienced at least three sessions of assisted reproduction before successfully conceiving. The subject was admitted for fever and short of breath, and was diagnosed with an influenza A virus infection. During the treatment process, the patient developed severe pulmonary infiltration and pneumonia, and was proposed for transfer to intensive care by physicians. The emergency care period was from February 18 to the 20th of 2018. Through observation, interviews with subjects and family members, and collection of clinical data, the author conducted an overall nursing assessment using Gordon's 11 Functional Health Patterns, and concluded the issues of the patient included impaired gas exchange, anxiety, and nervousness on the part of the care giver. During the care process, the subject was given oxygen aid and the bed was raised to increase circulation and improve breathing problems. Furthermore, the author listened and accompanied the patient during the care, and informed her the health status of the fetus, and guided her to share her concerns and feelings about the child. The author employed support and care from the family members in an attempt to reduce the her anxiety and self-blaming. During the hospitalization period, the husband of the patient also experienced greater stress due to inexperience in the care process. The husband was provided with guidelines on pneumonia care to increase the care skill and reduce anxiety. Finally, a healthy boy was born under the care of the medical team. Faced with the immediate response in an emergency medicine, medical staff often need to provide fast medical care to address the physiological needs within the short contact period with patients. Psychological support not only help alleviate the stress from panicking patients but also ease the burden on care givers as well. The author hopes to share this experience with other clinical nursing personnel who care patients with acute diseases..