一位長新冠併發肺纖維化個案之照護經驗

Nursing Experience for a Patient with Long COVID Complicated by Pulmonary Fibrosis

本文描述一位因感染嚴重特殊傳染性肺炎三個月後診斷長新冠症候群併發肺纖維化個案之照護經驗，因呼吸困難長期依賴氧氣導致身、心受到衝擊。護理期間自2023年10月24日至11月22日，筆者藉身體評估、觀察、會談及病歷資料收集等技巧，運用Gordon十一項功能性健康型態評估作為評估工具，以確立個案護理問題包含「低效性呼吸型態」、「活動無耐力」及「焦慮」。生理照護方面，除醫療處置外，藉由給予氧氣支持與教導噘嘴、腹式呼吸以改善肺部通氣；亦結合跨團隊照護，與復健科及營養科共同制定個人化復健計劃及營養配方，促進個案氧合功能以改善活動耐受性。在心理方面，筆者針對個案因疾病而焦慮的問題，藉由關懷、傾聽與個案建立良好護病關係，同時鼓勵個案及其家屬參與共同醫療決策，另藉芳香精油、音樂療法提供個案情緒出口，改善病人之焦慮問題。臨床上對於長新冠症候群有效的護理介入尚不明確，除生理層面的問題外，疾病亦造成顯著的心理衝擊，希望藉此經驗分享，以此類病人為鑒，共同提升病人之照護品質。

This report describes the nursing experience for a patient diagnosed with long COVID, complicated by pulmonary fibrosis, three months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Long-term dependence on supplemental oxygen due to dyspnea has had a significant impact on the physical and mental health of the patient. During the period of nursing care from October 24 to November 22, 2023, to identify nursing issues, the authors used physical assessment, observations, interviews, collection of medical records, and an assessment tool (Gordon’s 11-item Functional Health Patterns), which included“ineffective breathing patterns”,“activity intolerance”, and“anxiety”. In terms of physiological care, the patient received oxygen support and was instructed on multiple breathing techniques, for instance, pursed-lip and diaphragmatic breathing. The patient care also involved a multidisciplinary team, which included personalized rehabilitation and nutritional plans jointly developed by the rehabilitation and dietetics departments, to promote pulmonary function, thereby improving activity tolerance. Regarding psychological care, illness-related anxiety was addressed by establishing a strong nurse-patient relationship through empathetic communication and active listening. The patient and family were also encouraged to participate in shared decision-making. Furthermore, interventions such as aromatherapy and music therapy were implemented as an emotional outlet to alleviate anxiety. At present, it remains unclear as to which nursing interventions are effective for patients with long COVID. This disease leads to physiological issues and has a significant psychological impact on patients. Hence, by sharing our nursing experience, we hope to learn from this group of patients and work together to improve quality of care.