一位多重慢性病之肺炎老年病人合併急性譫妄的照護經驗

本個案報告旨描述一位多重慢性病老年肝癌病人因肺炎感染入院治療，照護過程出現急性譫妄之護理經驗，照護期間為2019年9月18日至2019年10月2日。筆者以Gordon十一項功能性健康評估模式蒐集主客觀資料，確立個案主要健康問題有急性譫妄與呼吸道清除功能失效，主要照顧者(案妻)因缺乏急性譫妄的認知與因應能力，致使出現緊張、擔憂與無助感的心理壓力，而出現照顧者角色緊張。筆者於個案急性譫妄期間，依據「處理譫妄根本原因」、「譫妄症狀處理」、「確保病人安全」以及「支持與衛教主要照顧者」四大原則，透過藥物、適當的安撫溝通技巧，增進個案安全感並使其能配合相關照護措施；在案妻的部份，引導案妻舒緩情緒壓力並參與介入措施以增加掌控能力，使其緊張情緒與挫折感得以改善。藉本個案照護經驗建議臨床護理人員未來照護急性譫妄病人時，除了處理譫妄根本原因、譫妄症狀處理及確保病人安全外，也應支持與衛教主要照顧者，透過與主要照顧者共同合作以提升病人照護品質。

This case study describes a nursing experience involving an elderly patient with multiple comorbidities, admitted for pneumonia and acute delirium. Throughout the hospitalization, the patient's wife experienced stress, anxiety, and helplessness due to her inability to care for her husband during his acute delirium episode. Data collection occurred from September 18 to October 2, 2019, utilizing direct nursing care, physical assessments, observations, and interviews guided by Gordon's 11-functional health assessment. It confirmed the main health problems as ineffective airway clearance, acute delirium, and caregiver role strain. Nursing interventions were developed, focusing on treating the root causes of delirium and managing symptoms, ensuring patient safety, and supporting the caregiver. These interventions involved medication administration, employing appropriate communication skills, and implementing practical strategies to enhance the patient's sense of security. Techniques such as chest percussion and encouraging deep breathing and coughing activities were utilized to aid in airway clearance. Furthermore, support was provided to the caregiver, encouraging her to express her feelings, guiding her in relieving emotional stress, and empowering her through participation in caring activities. As the patient's acute delirium gradually subsided, improvements were noted in the caregiver's stress and frustration levels. It is recommended that clinical nurses caring for patients with acute delirium prioritize not only managing the root causes and related symptoms but also paying attention to supporting caregivers. This holistic approach contributes to improving the overall quality of patient care.