照顧一位周產期窒息新生兒運用低溫療法之護理經驗

A Nursing Care Experience of a Newborn with Perinatal Asphyxia Using Hypothermia Therapy

本文主要探討一位周產期窒息新生兒之照護經驗，護理期間2019/2/12至2019/3/14，個案出生週數37+5週，出生時無呼吸、心跳，經醫師急救後入住加護病房，執行低溫療法以緩解因腦部損傷造成永久性神經學後遺症。個案因缺氧後造成神經腦病變為永久性且不可逆，執行低溫療法易造成的合併症，父母由迎接新生命的喜悅到錯愕及正視個案的後遺症，期間父母複雜的心情轉折而引發探討此個案的動機。筆者藉由系統性觀察、直接照護、病歷查閱及與父母會談等方式蒐集資料，運用羅氏適應模式進行評估，發現個案健康問題有：「氣體交換功能障礙」及「腦組織灌流改變」，個案母親（以下簡稱案母）有「照顧者角色緊張」問題。在照護過程中，運用發展性照護及寧握護理集中照護個案，適時安撫、適當擺位及減少環境刺激，以穩定氧合及降低低溫療法合併症發生，以家庭為中心關懷、同理及鼓勵父母，運用全人整合醫療照護病情討論會，提供個案及父母個別化照護需求，共同擬定照護計畫，緩解父母心中的焦慮，偕同父母參與個案照護，建立親子依附關係以提升父母照護技能，增加日後照護信心，使個案獲得持續且完整的全人照護。建議加護病房在新生兒病情穩定後儘早提供袋鼠式護理、哺餵母乳或唸書給新生兒聽以促進親子連結。

This study described a nursing care experience of a newborn with perinatal asphyxia from December 12 to March 14, 2019. This 37-week-5-day old newborn showed no breath and heartbeat during delivery, and was admitted to NICU after first aid. Therapeutic hypothermia was conducted to relieve permanent neurologic sequelae. This client suffered from irreversible and permanent neurologic damage and complications due to hypoxia and therapeutic hypothermia. The joy of having a new baby turned into a nightmare for the parents. Their emotional journey was the motivation of this case study. Systematic observation, direct care, medical records review and interviews were conducted to collect data. Roy's adaptation model was used for evaluation, and the health issues included (1) gas exchange impairment, (2) change in brain tissue perfusion, and (3) role stain of the caregivers. During nursing care, development care, containment and focused care was implemented. To reduce the complications due to therapeutic hypothermia, the client was soothed, proper positioning was performed and environmental stimuli was controlled. A family-centered care, empathy, and encouragement were provided to the parents. An individualized caring plan was designed based on holistic care model to relieve the anxiety of the parents. They were encouraged to participate in the caring process to establish parental attachment and increase caring skills. It is suggested that kangaroo care, breast feeding and parent-child reading were provided as soon as possible in NICU to facilitate parent-child connection.