照顧一位重症肌無力併發呼吸衰竭個案脫離呼吸器之加護經驗

Intensive Nursing Experience: A Case of Myasthenia Gravis Complicated with Respiratory Failure and Weaning off the Respirator

本文是照護一位50歲男性重症肌無力的個案，首次接受氣切手術呼吸訓練脫離呼吸器之加護經驗，護理期間為2019年5月23日至2019年6月9日，應用Gordon十一項健康功能型態為評估工具，以觀察、照護、身體評估及筆談等收集資料，評估發現個案三項護理問題：一、低效性呼吸型態，協助執行肺部復建運動並使用高頻胸壁壓縮機器協助拍痰，教導有效咳嗽技巧，有效將痰液咳出並即早脫離呼吸器；二、營養少於身體所需，提供適當營養支持維持身體營養所需，以減少體重流失及呼吸器使用天數；三、無望感，經醫師解釋治療方針及預後，藉由持續關懷並提供轉移注意力技巧，使個案表達內心感受，以逐漸減輕無望感。加護病房著重在急性期的照護，時常忽略個案除面對疾病所造成的生理不適外，未來無法回歸正常生活也備感擔憂，故建議照護此類個案於急性期提升個案及家屬對疾病之認識及照護能力，提供足夠的營養需求及執行肺部復健運動並鼓勵家屬一同參與，引導個案及家屬表達其感受並給予心理支持，以早期脫離呼吸器，進而改善生活品質。

This study describes the experience of caring for a 50-year-old male with myasthenia gravis in the intensive care unit. The patient underwent a tracheotomy for the first time andreceivedbreathing training in an attempt to weanhimself from a ventilator. The period is from May 23, 2019 to June 9, 2019. e Gordon’s 11 Functional Health Patterns were used to collect data for observations, care, physical assessment and written conversations. The assessment identifies three health problems: (1) Inefficient breathing patterns that were addressed using lung rehabilitation exercises and high-frequency chest wall oscillation to reduce sputum, teaching effective coughing skills, effectively coughing up sputum and weaning from the ventilator early. (2) Malnutrition, which was addressed using appropriate nutritional support to maintain the patient’s nutritional needs, ameliorateweight loss of the case and decrease the use of a respirator. (3) Hopelessness: whenthe doctor explained the treatment policy and prognosis, medical staff continued to care for the patient and taught attention-shifting skills to enable the patient to express feelings and reduce the sense of hopelessness. The intensive care unit focuses on care during the acute phase and often ignores the physicaldiscomfort that is caused by the illness or by worrying that it will not be possible to return to normal life. When caring for such cases, we suggest that knowledge of the disease and the ability to care for the patient needs to be improved in the acute phase. Nutritional demands andlung rehabilitation exercises requireto be satisfied. Family members are to be encouraged to participate. The patient and family members are encouraged to express their feelings and provide psychological support for weaning from the ventilator early and improve the quality of life.