一位呼吸衰竭老人脫離呼吸器之護理經驗

The Nursing Experience of An Elderly Person with Respirat ory Failure Being Wean ed Off A Vent ilat or

本文主旨描述照護一位呼吸器依賴糖尿病截肢暨中風老人的經驗，因家屬不常來探望導致個案有社交退縮及經常流淚的情形，加上呼吸肌無力及咳嗽能力弱等問題，較難脫離呼吸器，引發筆者欲協助個案克服上述問題。護理期間自2011 年5月3 日至6 月13 日於呼吸照護中心，運用身體評估、觀察、直接護理及與家屬會談等技巧收集資料，以生理、心理、家庭、靈性、社會文化等方面，進行資料分析，發現個案於護理期間有呼吸器戒斷反應功能失常及潛在危險性心靈困擾等健康問題。護理過程協助個案控制感染、調整營養，並訓練上肢肌肉及腹部肌肉的力量來增強呼吸肌肉的力量；傾聽及協助個案回顧過去的生活歷程，並整合個案的貢獻，進而對子女因忙碌而沒來探望的行為認知的轉念，減少壓力及不安，而改善心靈困擾的問題，協助成功脫離呼吸器。建議對於呼吸肌無力的老人，可運用巧思做成有趣的玩物或標語掛在點滴架上，激發老人上肢運動的動機；長期臥床的部份給予傾聽、交談以增加對於外界資訊的刺激，應用家庭以外的照護人力及資源改善心靈困擾問題，希望此護理經驗提供護理同仁做為日後護理相關老人問題之參考。

This article describes the nursing care of a diabetic elderly person at potential risk of spiritual distress related to respirator dependency, as well as stroke and above knee amputations. Since her family did not visit the client often, she was socially withdrawn and often wept. Due to weak respiratory muscles and coughing ability, the client was unable to wean herself off the ventilator. This situation motivated the author to take care of the client to overcome these health problems. The author took care of the client from May 3 to June 13, 2011 at a respiratory care center. Through observation, physical assessment, direct care, and interviews with family members, the author assessed the client’s physical, psychological, spiritual, family, social and cultural dimensions and analyzed the data. The diagnosed health problems included dysfunctional ventilator weaning response, and potential risk of spiritual distress et al. The nursing interventions included infection control and adjustments in nutrition. In addition, training of the client’s upper limb muscles and abdominal muscles was carried out to enhance the strength of the respiratory muscles. By listening and encouraging the client to review her life, we aroused her interest. We assisted the client in reversing the perception of the caring behaviors of her children to improve her spiritual health, and assisted her in successfully weaning herself off the ventilator. We suggest health care providers who take care of the elderly with respiratory muscle weakness utilize fun playthings or banners hanging on the drip rack, to inspire them to exercise their upper limbs. Health care providers of long term care centers should listen to their clients and increase the external information to stimulate conversation for clients lacking family support or social resources, and also apply for formal health care providers and social resources. We would like to share this caring experience and suggestions with nurses who are responsible for a patient with ventilator-dependency and potential spiritual distress.