照顧一位運用低溫治療之周產期窒息新生兒急性期護理經驗

Nursing Experience of a Newborn with Perinatal Asphyxia Using Hypothermia Therapy in the Acute Stage

本文主要是探討照顧一位新生兒因周產期窒息之急性期護理經驗，護理期間為2013年5月12日至2013年6月10日止，個案出生過程因周產期窒息缺氧，立即給予心肺復甦後轉至本院新生兒加護病房，入院後出現抽搐等神經異常症狀，經醫師評估建議家屬接受低溫治療來降低個案腦部受損。筆者藉由身體評估及系統性觀察等方式，確認個案主要健康問題為無效性保護能力、氣體交換障礙、潛在危險性嬰兒依附關係障礙。個案在低溫治療期間筆者除維持個案皮膚完整性、監測凝血功能、嚴格執行無菌技術和監測出血及感染症狀和徵象，還提供個案維持通氣穩定促進氧合功能，減少發生低血氧並協助個案逐漸脫離呼吸器；再藉由彈性會客促進親子依附關係建立，鼓勵案父母參與照護活動並學習照顧技能降低案父母之焦慮，共同擬定照護計畫，使個案獲得完整及持續性護理。

This article described the nursing care of a newborn with perinatal asphyxia in the acute stage. The study period was from May 12th, 2013 to June 10th, 2013. The patient received cardiopulmonary resuscitation immediately after birth at a local clinic, then transferred to our hospital NICU under the impression of perinatal asphyxia. Due to seizures and other neurological abnormalities, the patient underwent therapeutic hypothermia to attenuate the evolution of the brain insult. During therapeutic hypothermia. By using systemic assessment skills we were able to evaluate and define the patient’s physiological needs, which includes impaired gas exchange, ineffective protection, and risk for impaired parent/infant attachment. Accordingly, we aimed to maintain skin integrity, follow strict aseptic technique with patient handling, monitor, signs of bleeding and infection, provided a nursing care plan for the patient which included maintaining adequate oxygenation to stabilize the gas exchange, reducing incidence of hypoxemia, and timely weaning of the ventilator. To ease parental anxiety and improve counter attachment changes in the intensive care setting, we set up flexible visiting hours to encourage parent-child bonding. We also actively involved the parents in the care of their hospitalized infant. We also included the family in a discussion to establish comprehensive and sustainable nursing care plans.