一位急性呼吸窘迫症候群病患採俯臥治療的護理經驗

The Nursing Experience of caring a Patient with Acute Respiratory Distress Syndrome in Prone-position Therapy

本文描述一位62 歲女性因呼吸衰竭併發急性呼吸窘迫症候群，病患面臨換氣不足感受瀕臨死亡的威脅而產生負面情緒，醫療團隊運用俯臥治療改善病患氧合之護理經驗。照護期間為2012 年11 月14 日至2012 年11 月26 日，以Gordon 十一項功能性健康型態進行整體評估，藉直接護理、觀察、身體評估，使用紙筆、圖卡與病患會談的方式收集資料，確立病患有氣體交換功能障礙、呼吸道清除功能失效、潛在性皮膚完整性受損、無望感等護理問題。在護理過程中筆者提供個別性的護理措施，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，增進其信心及希望，並在病患無法清除痰液時，協助抽痰、維持呼吸道的通暢，當病患俯臥時使用水球及軟墊於骨突處避免壓瘡產生，且應用言語上的鼓勵、關懷和家屬支持等方法，增進病患的心理安適，讓病患能渡過這漫長的治療過程。在醫療團隊共同努力下，病患成功脫離呼吸器轉至胸腔內科病房，期望能藉由此照護經驗，做為未來照護相關病患的參考。

This article described the nursing experience of caring a 62-year-old woman with acute respiratory distress syndrome due to respiratory failure. She faced hypoventilation and threat of near-death experience that produced negative emotions. The author applied the nursing experience of prone-position therapy to improve oxygenation. Nursing Care was from November 14 to 26, 2012. Gordon 11 Functional Health Pattern was used to assess the patient’s health status. Data was collected through observation, direct care, and physical assessment, using writing, figure cards, and communication. The nursing care problems included impaired gas exchange, ineffective airway clearance, potential for impaired skin integrity, a sense of hopelessness. The authors provided individualized nursing care plans, including improving oxygenation in prone-position therapy, monitoring oxygen exchange, maintaining adequate ventilation, and enhancing confidence and hope. When the patient could not expectorate sputum by herself, assistance was provided to facilitate suction and maintain free airway flowing. To prevent pressure ulceration, water polo and cushion under bony prominences were provided. The patient was encouraged by nursing staffs and family support to receive the long-term treatment. The healthcare team helped the patient wean ventilator, thus transferred to chest medical ward.