一位食道癌病人術後成功脫離呼吸器之照護經驗

The Nursing Experience of a Post-Operative Patient with Esophageal Cancer Successfully Weaned from a Ventilator

本文主要描述一位62歲食道癌病人術後因呼吸肌無力引發呼吸器困難脫離之重症照護經驗。照護期間2014年7月6日至7月17日，藉由觀察、會談及直接照護的過程中，進行生理、心理、社會及靈性層面之整體性護理評估，確立個案有呼吸器戒斷功能反應失常、急性疼痛及身體心像紊亂等健康問題。於照護過程中，經由制訂呼吸器脫離模式、採取個別性肺部復健運動計畫、運用藥物及非藥物的疼痛緩解療法和與病人建立信任的護病關係，透過傾聽、澄清與關懷的方式，協助病人接受術後身體外觀的改變，最後得以恢復呼吸肌肉力量且成功脫離呼吸器。透過此次分享期望能提供醫療團隊照護上之參考。

This article describes the nursing critical care experience of a 62-year-old male with esophageal cancer post-operatively, who had difficulty in being weaned from a ventilator due to weakness of respiratory muscles. The nursing care period was from July 6th to July 17th, 2014. Holistic nursing care was performed to assess the physiological, psychological, social and spiritual conditions of the patient by observations, communication, and direct care of the patient. Identified nursing problems included the dysfunctional ventilator weaning responses, acute pain and body image disturbance. During the course of nursing care, the author set the adequate ventilator mode, designed the individualized pulmonary rehabilitative training plan, and provided medication and non-medication methods to maximize the patient’s comfort, as well as building a trust relationship with the patient through listening, clarifying and caring. The patient was assisted in accepting his change of appearance and regained the strength of respiratory muscles that ultimately led to success in weaning from the ventilator. It is hope that this experience could provide the medical teams with insight into further clinical care.