一位慢性阻塞性肺疾病成功脫離呼吸器病患的護理經驗

Nursing Experience Helping a Chronic Obstructive Pulmonary Disease Patient Successfully Wean from Ventilator

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）病患因疾病嚴重且複雜度高，疾病過程只能控制無法完全治癒，故一旦罹患此疾病及合併使用呼吸器，要進行呼吸器脫離是非常艱難。本文主要探討一位COPD病患因長期依賴呼吸器進行呼吸器脫離的護理經驗，護理期間為2009年5月12日至2009年6月2日，運用Gordon十一項功能性健康型態進行護理評估，經由會談、觀察、收集病史、病歷查閱、評估個案及直接護理，發現個案主要護理問題有：呼吸機械斷反應功能失常、活動無耐力、睡眠型態紊亂。筆者在照護期間與個案建立良好的治療性人際關係，採漸進式呼吸訓練方武，協助進行呼吸器脫離，並積極教導執行有效深呼吸咳嗽和呼吸肌力運動，以改善活動無耐力症狀，針對個案因疾病造成呼吸衰竭必須依賴呼吸器，導致影響睡眠品質，給予降低環境干擾因素及緩解對疾病的不確定感，儘早讓醫療團隊及個案、家屬參與進行脫離呼吸器計劃，並依循個案的症狀、反應和感受，提供更完整性的照護，進而成功脫離呼吸器。

Patients with COPD have varying degrees of disease severity and different complications. The disease can be controlled but not cured. Weaning a patient with COPD from a mechanical ventilator can be difficult. This article discusses the experience providing nursing experience weaning a patient with COPD from a mechanical ventilator on which he had depended for a long time. The nursing period was from 12th May, 2009 to 2nd June, 2009. Using Gordon 11-items of functional health pattern as nursing evaluation, counseling, observation, history taking, chart review, case evaluation, and direct nursing, we found that the main nursing problems to be ventilator dependence, exercise intolerance, and sleep disturbance. Once a good therapeutic relationship with the patient was established, we used stepped respiratory training, assisted ventilator weaning, and effective deep breathing practice, cough, and respiratory muscle exercises to build the patient's confidence and improve symptoms of exercise intolerance. To improve sleep quality, we lowered environmental interference and helped ameliorate uncertainty about the disease. The participation of the medical team, patient and the patient's family in the provision of care for the symptoms, the patient's response, and the patient's feelings helped the patient successfully relinquish his use of the mechanical ventilator.