一位異物哽塞急救後個案脫離呼吸器之護理經驗

Nursing Experience of A Patient with Ventilator Weaning with Foreign Body Choking after First Aid

本文為描述一位80歲男性個案，異物哽塞急救後氣管內插管合併呼吸器使用，於加護病房訓練二次未能成功，轉至亞急性呼吸照護病房之護理經驗。筆者於2013年12月10日至2014年1月4日，透過直接照護、觀察、筆談、理學檢查及健康評估、查閱病歷等方式收集資料，運用Gordon十一項健康功能型態評估確立三項護理問題有：呼吸器戒斷反應功能失常、睡眠型態紊亂及焦慮。運用專業知識、溫暖與關懷建立信任之治療性人際關係，並與家屬共同提供支持、克服焦慮增強信心、與醫療團隊合作最終成功脫離呼吸器，轉至一般病房並出院返家，期望提供護理人員日後照護呼吸器脫離個案，重視其身心衝擊與協助調適。

This nursing experience describes an 80 year-old man who, after choking on a foreign body and receiving first aid, underwent endotracheal intubation combined with respirator use. In an intensive care unit, the patient twice experienced unsuccessful ventilator weaning, before being transferred to a respiratory care unit (RCU). The nursing period was from 10th December 2013 to 4th January 2014. The authors used Gordon's 11 functional health patterns assessment together with direct care, observations, written communication, physical examinations, health assessments and medical reports to collect the data. After organization and analysis, the nursing problems were determined as a dysfunctional response to ventilator weaning, disturbance of sleep patterns, and anxiety. The authors, by applying their professional knowledge, built a warm and caring treatment relationship, providing support to the family and collaboration with the medical team, all of which helped the patient conquer his anxiety and enhanced his confidence. Finally, following successful weaning off of the ventilator, the patient’s recovery eventually led to discharge from the RCC and the general ward. In the future, with regards to ventilator weaning cases, nurses should pay particular attention to the physical and psychological impacts and help patients to adapt.