肺部復健訓練應用於長期依賴呼吸器病人之護理經驗

A Nursing Experience of Pulmonary Rehabilitation Training Applied to Long-Term Ventilator Dependent Patient

本文描述一位74歲男性因肺炎併發呼吸衰竭，導致長期依賴呼吸器而轉入本呼吸照護病房，進行脫離呼吸器訓練之護理經驗，護理期間為2013年2月26日至4月1日，運用Gordon十一項健康功能型態評估，藉由觀察、會談、身體評估、病歷查閱等方式收集資料分析歸納後，確立個案有呼吸機戒斷反應功能失常、焦慮、睡眠型態紊亂等三項主要健康問題。在護理過程中針對個案有抽菸習慣及慢性阻塞性肺部疾病病史，導致呼吸肌力量及耐力日漸衰弱，運用肺部復健訓練提供個別性及獨特性之脫離呼吸器計畫，並藉由家屬的支持與參與，讓個案能減輕內心焦慮，適時滿足其舒適感與安全感，使個案最後終於成功脫離呼吸器，進而移除氣切管路順利出院，並達到自我照顧之目的。

This article described the experience of caring a 74-year-old man with pneumonia complicated by respiratory failure that resulted in long-term ventilator-dependent. The nursing experience began after the patients was transferred to the respiratory care ward where ventilator weaning was conducted during the period from February 26 to April 1 in 2013. The author assessed the patient based on Gordon’s eleven functional health patterns. Data were collected through observation, interview, physical assessment, and medical record review After analysis, three major health problems were noted, including dysfunction alventilator weaning response, anxiety, and disorder sleep pattern. The nursing process concentrating on alleviating the frailty caused by smoking-related chronic obstructive pulmonary disease and weaken respiratory muscle strength and endurance. Individualized pulmonary rehabilitation training and unique weaning were also provided the patient’s anxiety was reduced and comfort and security were achieved. Finally, weaning was successful and the tracheostomy was removed. The patients was discharged and could achieve the goal of self-care.