顱內動脈瘤破裂併發神經性肺水腫患者之加護照護經驗

Nursing Care of a Patient with Rupture of Intra-cranial Aneurysm Complicated with Neurogenic Pulmonary Edema in the Critical Care Uni

本個案報告是探討照顧一位顱內動脈瘤破裂併發神經性肺水腫患者及其家屬之加護護理經驗。個案因顱內動脈瘤破裂，經開顱術後轉至神經外科加護病房，六小時後出現呼吸喘、低血氧、囉音、粉紅色泡沫狀痰液及胸部Ｘ光片兩側肺浸潤，懷疑為神經性肺水腫。給予支持療法，矯正低血氧，預防顱內壓上升及鎮靜治療。自年月日到月日筆者照顧期間運用十一項功能性健康評估並藉由觀察、家屬會談收集資料，確立其有腦組織灌流改變、氣體交換障礙、身體活動障礙、高危險性感染、高危險性照顧者角色緊張等健康問題，同時針對個案問題給予嚴密的監測、治療及個別性的護理措施，適時解決其護理問題，教導家屬參與照護過程，積極協助家屬因應其所面臨的壓力並渡過危機，使個案病情漸趨穩定，轉至普通病房。期望藉此護理經驗之分享，提供護理同仁照顧神經性肺水腫病患之參考。

I am looking forward to sharing and discussing the nursing experience of a casewith a rupture of intra-cranial aneurysm complicated with neurogenic pulmonaryedema and communicating with his family in the critical care unit. This patient sufferedfrom rupture of intra-cranial aneurysm and was transferred to the intensivecare unit after craniotomy. Six hours later, abnormal findings including dyspnea,hypoxemia, rales, pink foamy sputum and bilateral pulmonary infiltration on chestx-rays were noted and neurogenic pulmonary edema was highly suspected. Supportivetreatment, correction of hypoxemia, prevention of increasing intra-cranial pressureand sedation were provided. From March 3rd to March 29th 2004, we appliedthe 11 functional health assessments of Gordon and collected essential informationaccording to observation of this case and communication with his family. Finally,we identified 5 problems in this case including altered blood perfusion of the brain,impairment of gas exchange, impairment of physical mobility, risk of infection andcaregivers' role strain. With strict monitoring, we had provided treatment and personalnursing management in order to solve the nursing problems promptly. Wealso taught his family how to participate in the caring process and helped them facethe emotional stress and to deal with the crisis. The condition of this case becamestable gradually and finally he was transferred to ward.