照護一位韋格納氏肉芽腫病人行肺臟移植之加護經驗

The Nursing Experience of a Wegner's granulomatosis patient undergoing Lung Transplant

本文描述一位因韋格納氏肉芽腫復發導致肺臟嚴重纖維化，接受大愛捐贈肺臟移植個案之加護病房照護經驗。本文個案為一位診所醫師，面對疾病的挑戰，個案歷經身份轉換及身心的衝擊。照護期間2022年7月19日至2022年7月29日，藉由筆談溝通、傾聽、觀察及身體評估等方式收集資料，並運用Gordon十一項健康功能型態進行整體性評估，確立個案有急性疼痛、呼吸道清除功能失效、活動無耐力、低自尊等健康問題。運用非藥物介入措施緩解個案傷口的疼痛；教導個案正確呼吸方式及咳嗽技巧，維持呼吸道通暢，跨領域團隊與醫師、物理治療師討論後，設計具個別性的復健計畫，協助個案執行復健，解決個案呼吸道清除功能失效及活動無耐力問題；以圖畫及書寫日記方式克服加護病房病人使用呼吸器無法輕易使用言語表達內心感受的障礙，引導個案表達內心感受，並有重要家人支持鼓勵，逐漸讓個案找回自尊及對自我的認同。肺移植病人術後血液動力學及呼吸狀態穩定，就能及早接受具個別性復建計畫，轉銜至病房時透過復健治療安排，維持復健的連續性，早期恢復健康，期望藉由此護理經驗，分享給臨床護理人員，作為照護參考。

This article describes an intensive care unit (ICU) nursing experience with a patient who presented with relapses of Wegener's granulomatosis, which progressed to severe pulmonary fibrosis, ultimately requiring a lung transplant. The patient, a primary care physician, experienced a transformation of identity and both physical and mental discomfort as the illness progressed. The authors identified the patient’s health problems, including acute pain, ineffective airway clearance, activity intolerance, and low selfesteem, from July 19th to 29th, 2022. These issues were assessed using Gordon’s 11 Functional Health Patterns and through data collection via communication, listening, observation, and physical assessments. Non-pharmaceutical interventions were employed to relieve the patient's pain, and we taught him effective breathing and coughing techniques to maintain airway patency. A customized rehabilitation program was designed, and cross-disciplinary teamwork was used to address ineffective airway clearance and activity intolerance. We encouraged the patient to draw and write in a diary to express his feelings and involved his family in providing mental and emotional support during his time on the ventilator. Gradually, the patient regained his self-esteem and sense of identity. If lung transplant recipients’hemodynamic and respiratory status are stable, early and individualized rehabilitation should be implemented. Upon transfer to the ward, continued rehabilitation activities can be arranged to maintain the rehabilitation plan. We hope this nursing experience can serve as a valuable reference for clinical nurses in future care.