罹患先天性橫膈膜疝氣新生兒之護理經驗

Nursing Experience of Caring for a Newborn with Congenital Diaphragmatic Hernia

本文為探討照護一位罹患先天性橫膈膜疝氣新生兒之護理經驗，筆者運用觀察、會談及Gordon十一項健康功能模式來評估個案及案父母的健康問題，個案部份包括氣體交換功能障礙、呼吸道清除功能失效、營養狀況改變少於身體需要，案父母方面則有焦慮及潛在危險性父母-嬰兒依附關係改變。個案於急性期因肺部呈現肺高壓而使用一氧化氮治療，同時也因時常出現低血氧造成呼吸器使用時間延長。筆者於照護期間，藉由個別化護理措施，提供個案舒適、滿足其需求、減少低血氧之發生、並促進呼吸器的脫離、進而拔除氣管內管與順利進食。針對案父母之焦慮及依附關係改變，筆者運用同理心，抒發案父母之負向情緒，採彈性會客之方式，促進親子依附關係建立，讓家屬參與照護活動，學習照顧技能，使個案能順利返家。希望藉此篇個案報告提供護理經驗給相關臨床照護工作之參考。關鍵詞：先天性橫膈膜疝氣、新生兒、護理經驗。

This article discusses the nursing experience of caring for a newborn with congenital diaphragmatichernia. The author evaluated health status of the client and parents by using observations,interviews, and 'Gordon's 11 items of functional health condition' to identify their health problems.The health problems of the client included impaired gas exchange, ineffective airway clearance,and nutritional deficit. The health problems of the parents were anxiety and risk altered for parent/infant attachment. Owing to pulmonary hypertension and frequent desaturation, the client wastreated with inhaled nitric oxide and prolonged the ventilator usage. During the period of nursingprocesses, the author applied individualized nursing interventions to help the client feel comfortableand to meet the client's need to facilitating from weaning ventilator and to initiating feeding.The author also used the strategies of empathy to help parents release negative emotions andoffered flexible visiting hours to build parent/infant attachment for encouraged parents to participatein caring activities and to learn the skills of self-care. Finally, the client went home successfully.I hope this nursing experience will serve as a reference for clinical staff in their clinical practices.