照護一位末期腎衰竭合併代謝性酸中毒且呼吸器依賴患者的照護經驗

An Intensive Care Experience of a Ventilator-dependent Patient with Chronic Renal Failure and Metabolic Acidosis

本文敘述一位慢性腎衰竭合併代謝性酸中毒且經歷多次脫離呼吸器失敗，所引發的生理及心理衝擊的相關護理問題。照護期間為2014 年4 月19 日至6 月17 日，以觀察、溝通及身體評估等方式收集資料，進行生理、心理、社會及靈性整體性護理評估，確立其健康問題，有氣體交換功能障礙、感染及無望感。以關懷理論為基礎，發展護理措施協助個案及家屬，藉由提供支持、保護性環境，與病人及家屬建立互相信任的人際關係，接受病人正向及負向的情緒感受，與醫療團隊密切合作，共同擬訂呼吸訓練計畫，並運用關懷、支持、陪伴與鼓勵，引導個案及家屬抒發情緒，面對疾病及死亡過程，期望藉由本文提供臨床護理人員之參考。

This paper describes an intensive nursing care experience of a patient whose condition was complicated by chronic renal failure with metabolic acidosis and repeated ventilator weaning failures that had serious physiological and psychological impacts. The period of nursing care was between April 19 to June 17, 2014. The clinical data was collected and assessed through observation, communication and physical assessment. According to holistic nursing assessments of the physiological, psychological, social and spiritual aspects, the patient’s health problems included gas exchange impairment, infection, and hopelessness. Watson’s caring theory was used to develop a nursing intervention for the patient and family, including providing a supportive and protective environment, establishing a relationship of mutual trust, and accepting their positive and negative emotional feedback. Cooperation with the medical team, collaboration on the development of the respiratory training program, as well as the use of caring, support, companionship and encouragement in the nursing process to guide the patient and family members in the expression of their emotions and to come to terms with the disease and death. We hope this report can provide our experience as a reference for clinical nurses.