照護一位硬皮症併肺纖維化行肺臟移植病人之加護護理經驗

The Intensive Nursing Experience of Caring a Lung Transplantation Patient with Scleroderma and Pulmonary Fibrosis

本個案因硬皮症導致肺臟器官纖維化，而需接受肺臟移植手術，術後常有緊張、不斷反覆詢問自己復原狀況等問題，引發筆者深入探討之動機，照護期間為2020年8月19至8月26日，藉由實際照顧、觀察、會談溝通、傾聽及身體評估等方式收集資料，運用Gordon十一項健康功能型態作為評估指引，進行整體性評估及資料收集分析，確認個案有焦慮、疼痛、低效型呼吸型態等健康問題；照護過程中，照護措施一、換藥前播放電視轉移注意力、採舒適臥位；二、利用枕頭放於胸腹固定管路後活動、束腹帶固定傷口，減少換藥、傷口拉扯時造成之疼痛不適；三、透過教導有效深呼吸咳嗽、使用誘發呼吸訓練計，合併呼吸肌訓練、四肢運動復健及下床活動，改善呼吸型態；此外，每日固定安排20分鐘陪伴個案，教導個案將問題作筆記，主動與醫師討論個人的治療計畫，增加個案對疾病照護認知，並採開放式溝通，引導個案表達內心感受，建立信任的護病關係，鼓勵個案共同參與照護活動，當個案有進步時，給予口頭鼓勵，減輕個案面對術後無法自我照顧的不安情緒。因肺臟為大愛捐贈者之器官移植，建議於接受移植手術前，可安排肺移植成功病友座談會，分享心情及治療經驗，以降低手術前、後的焦慮程度。

This case study focuses on a patient with pulmonary fibrosis due to scleroderma who underwent lung transplantation and experienced anxiety about their recovery status. From August 19 to 26, 2020, data was collected through physical assessments, observations, and communication during ICU daily care. Using Gordon's eleven functional health patterns as a guideline, the patient's health problems, including pain, ineffective breathing patterns, and anxiety, were identified. To address these issues, various methods were employed, such as distracting the patient during dressing changes, improving their lying position, and using pillows and abdominal binders to reduce post-operative pain. The patient's breathing pattern was improved through instruction on deep breathing, coughing, and respiratory muscle training, as well as limb exercise rehabilitation and ambulation. Open communication and emotional support were also provided through daily accompaniment sessions, encouraging the patient to express their feelings and participate in self-care. The patient's anxiety was alleviated through encouragement and positive reinforcement, and it is recommended that a symposium be arranged for patients who have undergone successful lung transplantation to share their experiences and reduce anxiety pre- and post-transplantation.