照顧一位顎裂早產兒合併呼吸窘迫症候群之護理經驗

A Nursing Experience in the Care of a Preterm Infant with Cleft Palate Combined with Respiratory Distress Syndrome

本文敘述照顧一位顎裂早產兒合併呼吸窘迫症候群之護理經驗，護理期間為2022年06月13日至2022年07月31日，筆者運用系統性身體評估進行評估，藉由直接及間接護理、身體評估、臨床觀察與會談方式收集相關資料，歸納出主要健康問題為氣體交換障礙、低效性嬰兒哺餵型態及潛在危險性依附關係障礙。護理期間提供個別性照護，協助護理問題獲得改善，依早產兒情形維持呼吸道通暢，以促進氧合穩定，吸吮吞嚥動作不協調方面，在每次由口餵食前，給予口腔按摩幫助口腔整合，促進吸吮吞嚥動作協調，顎裂患者常見的感染問題，藉由選擇特殊奶嘴及奶瓶，餵食過程採取半坐臥姿勢來減少吸入性肺炎。家屬的焦慮不安經由醫療團隊主動告知病情，再依個別性提供適當的護理措施，鼓勵家屬參與日常照護，以回覆示教的方式提升照護技能及減少家屬心理壓力，增加家屬照護上的信心。希望藉由此次照護經驗，提供同仁在臨床照護上之參考，並建議未來臨床醫療人員能重視早產兒口腔訓練的重要性，助於每位早產兒能縮短管灌至口餵食過渡期，以縮短住院時間，盡早出院返家，提升早產兒照護品質。

This article describes a nursing experience in caring for a preterm infant with cleft palate and respiratory distress syndrome. The nursing period spanned from June 13 to July 31, 2022. A systematic physical assessment was conducted, and data were collected through direct and indirect nursing care, physical evaluations, clinical observations, and interviews. The primary health problems identified were: impaired gas exchange, ineffective infant feeding pattern, and potential risk for impaired parent-infant attachment. Individualized care was provided during the nursing period to address these issues. Airway patency was maintained according to the infant's condition to promote stable oxygenation. For the problem of uncoordinated sucking and swallowing, oral massage was performed before each oral feeding to support oral motor integration and enhance coordination. To reduce the risk of aspiration pneumonia, which is common in infants with cleft palate, a specialized nipple and feeding bottle were used, and the infant was fed in a semi-upright position. To relieve the family's anxiety, the medical team proactively communicated the infant's condition and provided appropriate, individualized nursing interventions. Family members were encouraged to participate in daily care routines. Demonstration-based teaching was used to improve caregiving skills, reduce psychological stress, and enhance their confidence in caregiving. It is hoped that this nursing experience may serve as a reference for clinical practice. It is also recommended that healthcare professionals place greater emphasis on the importance of oral training for preterm infants, as it can help shorten the transition period from tube feeding to oral feeding, reduce the length of hospital stay, and improve the quality of care for preterm infants.