照顧一位慢性阻塞性肺病感染新冠肺炎之護理經驗

A Nursing Experience of a Patient with Chronic Obstructive Pulmonary Disease, Diagnosed of COVID-19 During the Pandemic

個案確診新冠肺炎致呼吸困難、氧氣需求高，在高流量氧氣鼻導管治療期間，無力感產生，引發動機想了解其心路歷程。慢性阻塞性肺病合併肺炎時，引發身心理壓力，使用高流量氧氣鼻導管改善氧合及利用賦權概念降低無力感，想藉由實際照護了解其成效。運用Gorden 11項健康功能評估，確認健康問題有低效型呼吸型態、潛在皮膚完整性受損、無力感等。照護過程，給予氧氣、藥物及肺復原；無力感透過主動關懷、音樂治療，增加自我控制感及自我照護。個案使用高流量氧氣鼻導管時，機器效果使痰液易排出，搭配肺復原，病情逐漸改善。無力感，藉由多元護理措施，逐漸提升其自我價值感。慢性阻塞性肺病感染新冠肺炎後，症狀較嚴重，建議照顧此類病人，給予肺復原運動及多元照護措施增強心理建設，促進復原能力，已提供日後照護的參考。

The severe pneumonia triggered by COVID-19 has led to an increased demand of oxygen and dyspnea, and the patient started to use high-flow nasal cannula oxygen during hospitalization. A sense of powerlessness caused by the long isolation treatment period, prompting the author to delve deeper into the patient's psychological journey. When chronic obstructive pulmonary disease is complicated by pneumonia, it will induces psychological stress. Using high-flow nasal cannula oxygen therapy to improve oxygenation and employing the concept of empowerment to reduce feelings of powerlessness. Aim is its effectiveness through nursing care. Applying Gordon's eleven functional health patterns assessment, health issues including inefficient breathing pattern, potential risks like impaired skin integrity and feelings of powerlessness. In the nursing process, oxygen, medications and pulmonary rehabilitation are provided. Feelings of powerlessness are addressed through proactive support and music therapy to enhance the sense of self-control and self-care. Combine with pulmonary rehabilitation and using high-flow nasal cannula oxygen therapy, the effectiveness of the machine facilitated help clean secretions, and gradually led to the improvement of the condition. Feelings of powerlessness were gradually alleviated through various nursing process, enhancing the sense of self-worth. Symptoms of patients with chronic obstructive pulmonary disease are more severe after being infected with COVID-19. It is recommended to take care of such patients and provide pulmonary recovery exercises and multi-care strategies to enhance their psychology and promote recovery capabilities. I hoped that this nursing experience sharing will serve as a reference for future care of similar patients.