照護一位A型流感合併急性呼吸窘迫症候群脫離呼吸器之護理經驗

Nursing Experience of a Patient Influenza-A infection Complicated Acute Respiratory Distress Syndrome with Ventilator Detachment

本文描述一位A型流感合併急性呼吸窘迫症候群使用呼吸器之護理經驗，護理期間自2019年1月31日至2019年2月11日，藉由病歷收集資料、觀察、筆談、會談及身體評估等方式蒐集相關資料，並運用Gordon十一項功能健康型態進行整體性評估，確立個案主要健康問題有：氣體交換障礙、體溫過高及焦慮。在護理過程中筆者提供個別性的護理措施，藉俯臥姿勢改善氧合狀態，監測血氧變化，進而維持足夠換氣，並在病患無法清除痰液時，協助抽痰、維持呼吸道的通暢；持續經由監測病人的體溫，注意補充體液，進而減少了發燒的不適情形；在心理層面提供個別性護理，運用傾聽、陪伴及衛教等方式，增強自信心，減少因健康狀況受到威脅、環境改變而引發之焦慮。在醫療團隊共同努力下，病患成功脫離呼吸器轉至胸腔內科病房。期望此照護經驗將有助提升護理專業照護品質及爾後同仁執行俯臥治療於臨床照護之參考，也建議制定俯臥治療照護製成影片光碟或手冊，做為未來照護相關病患的參考。

This article describes a Patient Influenza-A infection Complicated Acute Respiratory Distress Syndrome with Ventilator Detachment. The nursing period was from Jan 31 to Feb 11, 2019. Data were collected through observation, interview, written conversations and chart review according to the holistic assessment. Gordon's 11 Functional Health Patterns Assessment was used. The nursing care problems gas exchange barrier, hyperthermia, and anxiety. The authors provided individualized nursing care plans, including improving oxygenation in prone-position therapy, monitoring oxygen exchange, maintaining adequate ventilation. When the patient could not expectorate sputum by herself, assistance was provided to facilitate suction and maintain free airway flowing. Continuously monitor the patient's body temperature and pay attention to replenishing body fluids to reduce the discomfort of fever. With regard to psychological care, the care-giver provided individualized care, and used listening, companionship, enhancing confidence and hope and health education to reduce the patient's anxiety due to health threats and environmental changes. The healthcare team helped the patient wean ventilator, thus transferred to chest medical ward. Our experience may provide a reference for prone ventilation. A well-designed educational handout or video may be helpful in clinical practice. This article hopefully can be a caring reference for others with similar patients in the future.