照顧一位極低體重早產兒合併壞死性腸炎之護理經驗

Nursing Experience of Caring for a very Low Birth Weight Premature Infant with Necrotizing Enteritis

本文乃照顧一位極低體重早產兒且合併壞死性腸炎的護理經驗，壞死性腸炎為早產兒常見併發症之一，筆者第一次照顧壞死性腸炎個案，於照護過程中發現個案病情變化迅速，故想深入探討如何照護方能避免病情繼續惡化。照護期間自2019年10月4日2019年1月5日藉由系統性身體評估、實際照護、觀察與會談等方式，確立健康問題為：一、低效性呼吸型態/與早產兒肺部發育不成熟有關；二、營養不均衡:少於身體需要/與壞死性腸炎引發的有關；三、照顧者角色緊張/與父母對疾病不了解及缺乏照顧經驗有關。筆者擬定個別性照護措施，包含：提供個案維持通氣穩定促進氧合功能，減少發生低血氧並協助個案逐漸脫離呼吸器；提供全腸道、靜脈營養及奶品添加高熱量營養品增加個案每日所需熱量;透過傾聽及溝通的方式了解個案父母想法，並協助案父母參與及討論個案治療計畫，以降低照顧者的焦慮緊張。因此個案為早產兒，無法如成人般自主表達身體的不適，只能依醫護人員對於疾病症狀的觀察及了解才能發現問題，建議可以多舉辦壞死性腸炎相關課程，以提高護理人員對疾病了解與認知，當發現異常症狀時，讓個案及早治療，減少疾病合併症的發生。

This article describes the nursing experience of caring for a very low birth weight premature infant with necrotizing enteritis, a common complication among premature infants. The case highlighted the rapid progression of the disease, prompting an in-depth discussion of this condition. The nursing period was from October 14, 2019, to November 25, 2019. Through systematic physical assessments, direct care, observations, and interviews, several health problems were identified: 1) Inefficient breathing patterns due to immature lung development associated with necrotizing enteritis; 2) Nutritional imbalance, with intake falling short of the body’s needs due to necrotizing enteritis; 3) Caregiver role strain, related to the parents' lack of disease knowledge and experience. To address these issues, the author implemented individualized care measures, including ensuring stable ventilation to support oxygenation and reduce hypoxia, gradually weaning the infant from the ventilator; providing both enteral and parenteral nutrition to meet the daily caloric needs for weight gain; and engaging in active communication with the parents to understand their concerns, involve them in the treatment plan, and alleviate their anxiety and tension. Since premature infants cannot autonomously express discomfort, it is crucial for medical staff to detect symptoms through observation and understanding. It is recommended that more disease-related educational courses be conducted for nursing staff to enhance their understanding of such conditions. This approach will enable early detection and treatment of abnormal symptoms, reducing the risk of disease complications.