照護一位先天性肺部囊腫腺瘤樣畸形病嬰之加護護理經驗

An ICU Nursing Experience of Caring for a Newborn with Congenital Cystic Adenomatoid Malformation

本文係描述一位罹患先天性囊腫腺瘤樣畸形病嬰，執行左肺局部切除後，在加護病房期間的護理經驗，護理期間為2011年9月3日至9月25日，筆者以系統性評估透過直接觀察、照護與家長會談，確認病嬰主要健康問題有：低效性呼吸型態及手術傷口與引流管留置引發的疼痛，筆者亦發現父母在病嬰住院期間有焦慮及照顧者角色緊張的問題。因此針對上述健康問題配合發展性照護，提供適當擺位，幫病嬰維持最佳胸廓起伏，促進氧合，及適時安撫、集中照護減少環境過多刺激，並與父母建立互信的人際關係，以人性關懷支持父母之負面情緒，減輕父母的焦慮與緊張，提供彈性會客促進親子依附關係建立，協助父母熟悉病嬰行為及參與照護活動，學習照顧技能，提供以家庭為中心的照護，使病嬰順利返家，讓病嬰獲得妥善的照顧。此個案為臨床少見案例，期盼藉此護理經驗，提供日後照護類似疾患護理人員之參考。

This article describes an ICU nursing experience of caring for a newborn with congenital cystic adenomatoid malformation after receiving left-lung segmentectomy during the period 2011/09/03 to 2011/9/25. Through a systemic assessment by direct observation, care and discussion with the family, the author confirmed the patient's major health problems as an ineffective breathing pattern; the pain caused by the surgical wound and drainage. The author also learned that the patient's parents were anxious and nervous during the hospitalization days. Therefore, to deal with the patient's aforementioned health problems by developing care, we provided an adaptive position, helped the patient maintain the best lung inflation, promoted oxygenation, and took measures to reduce any excessive environmental stimulation in order to provide the patient with as much tranquility and peace as possible. We also provided proper patient care by building up mutual trust with the parents, supporting the parents' negative emotions by showing a caring attitude, reducing the parents' anxiety and nervousness, providing flexible visiting hours to build up the parent-child relationship, helping the parents understand the patient's behavior, and supplying family-centered care by training the family how to participate in the care and teaching them the required care skills to facilitate a smooth return home. This was a rare case in clinical experience, and we hope that this case can serve as a reference for nurses presented with similar cases in the future.