協助一位乳癌病人成功脫離呼吸器之照護經驗

The Nursing Experience of Assisting a Breast Cancer Patient to Successfully Get Out of Respirator

本文描述一位乳癌細胞轉移至肺部合併呼吸衰竭，導致困難脫離呼吸器之個案，因為個案呈現高度焦慮，故引發收案動機，期望經由協助能成功脫離呼吸器，護理期間為2018年11月1日至11月30日，藉由直接護理、會談、觀察及身體評估收集資料，運用Gordon十一項健康型態評估，確立健康問題有呼吸道清除功能失效、身體心像紊亂及焦慮等。照護期間讓個案參與呼吸訓練計劃討論，以建立個別性護理措施，包括胸部扣擊、震顫及姿位引流技巧，避免痰液積存；針對身體心像紊亂之健康問題，提供氣切傷口癒合的照片，分享衣服穿搭方式，以增加安全感；進行呼吸器脫離訓練期間，除三班固定護理人員照護外，教導調適呼吸及轉移注意力的方法，最後完成呼吸訓練，並達到減輕焦慮的目標，而順利出院，建議未來可運用平板於需要筆談的個案，以達有效溝通及降低個案焦慮現象。

This article describes the nursing care of a patient with breast cancer and lung metastasis complicated by respiratory failure, resulting in difficulty weaning from mechanical ventilation. The nursing period spanned from November 1 to November 30, 2018. Data were collected through direct care, interviews, observation, and physical assessment. Using Gordon’s 11 Functional Health Patterns for comprehensive evaluation, the major nursing problems identified were ineffective airway clearance, psychological distress, and anxiety. Individualized nursing interventions were implemented to address these issues. Airway management included chest care, vibration therapy, and postural drainage techniques to facilitate sputum expectoration and prevent pulmonary infection. The patient was instructed in deep-breathing and effective coughing techniques to maintain airway patency. Active participation was encouraged through collaborative development of a personalized respiratory training plan and implementation of chest rehabilitation exercises to enhance confidence and functional recovery. To support emotional adaptation, photographs showing the healing process of the tracheostomy wound were shared with the patient to increase awareness of progress. Guidance on clothing selection, such as silk scarves and turtlenecks, was also provided to promote comfort and a sense of security.
During ventilator weaning training, continuous nursing support was delivered across three shifts. Nurses actively listened to the patient’s concerns, provided breathing guidance, and used distraction techniques such as music therapy to alleviate anxiety. Following these interventions, the patient demonstrated improved cooperation and successfully completed ventilator weaning. This case highlights the significance of individualized, holistic nursing interventions for patients with advanced cancer and respiratory failure. By integrating physiological care with emotional support, nurses can enhance patient confidence, facilitate ventilator weaning, and improve overall quality of life. This nursing experience serves as a valuable reference for developing personalized care strategies in similar clinical situations.