照顧一位肺移植病人術後之加護護理經驗

The Intensive Care Nursing Experience of Caring a Patient Receiving Lung Transplantation

本文探討一位特發性肺纖維化病人接受肺移植手術之護理經驗，護理期間為2020年12月11日至12月24日，筆者藉由觀察、筆談、身體評估及查閱病歷等方式，以Gordon十一項健康功能性評估，確立活動無耐力、氣體交換障礙、害怕等健康問題。照護期間監測尖峰吸氣壓力、潮氣容積、胸部X光變化及呼吸器脫離訓練，幫助病人順利脫離呼吸器，並藉由早期身體活動介入，執行肺復健運動，讓病人肺功能維持於最佳狀態。在護理過程中指導病患放鬆技巧、透過主動關懷，建立良好護病關係，引導病人情緒表達，增加安全感，另透過跨團隊會議與協調，使其正向且有信心的面對後續復健之路。惟肺臟移植案例少，讓肺移植患者瞭解治療過程、經驗分享與交流的機會少，建議能針對肺移植病友建立通訊群組，提供病友間經驗分享，期望藉由此護理經驗分享，提供日後在照顧此類個案時之參考，共同協助病人重獲新生。

This article describes the nursing care experience of a patient with idiopathic pulmonary fibrosis who received a lung transplant. The nursing care period spanned from December 11 to 24, 2020. Data was collected through observation, conversation, physical examination, and review of the patient’s medical history, in accordance with Gordon’s 11 Functional Health Patterns. Health-related problems included activity intolerance, impaired gas exchange, and fear. During the care period, we monitored peak inspiratory pressure, tidal volume, chest X-rays, and the weaning ventilator program. These interventions helped facilitate smooth ventilator weaning. Pulmonary rehabilitation exercises were also performed through early physical activity intervention to maintain the patient’s lung function. Throughout the nursing process, we taught the patient relaxation techniques, established a positive relationship through active care, encouraged the expression of emotions, and helped increase the patient's sense of security. Additionally, through interprofessional collaborative meetings and coordination, we supported the patient in facing follow-up rehabilitation with positivity and confidence. Since lung transplant cases are relatively rare, patients often struggle to fully understand the treatment and may lack opportunities to share their experiences. Therefore, we recommend the establishment of a lung transplant patient association to provide a platform for patients to share experiences and encourage one another. By sharing this nursing experience, the author hopes to assist nursing colleagues in caring for similar cases in the future, ultimately helping patients lead a new life after a lung transplant.